Abstract
Hypercalcemia. is a frequently encountered finding during the routine work-up of patients..%90 of hypercalcemias are due to malignencies and hyperparathyroidism. Other causes of hypercalcemias are vitamin D and vitamin A intoxication, side effects of treatment with thiazide diuretics, theophyllins, lithium like medications and other rare causes.. We present an 82 year old woman with a blood calcium level 15,9mg/dl,who did not respond to vigorous rehydration and diuretic treatments .However she responded promptly to treatment with Pamidronate. We have ruled out the causes of hypercalcemia in this patient and decided that patient's use of hydrochlorotiazides as antihypertensive medication for a long time , her age related physical inactivity ,consumptiom of extra calcium ,dehydration and consequently the suppression of parathyroid activity are the main causes of severe and dangerous level of hypercalcemia in this patient .
Keywords
References
- Uysal A.R. Primer Hiperparatiroidizm ve Hip- erkalsemi, Sekonder Hiperparatiroidizm. Erdoğan G. Koloğlu Endokrinoloji Temel ve Klinik,2.baskı,Ankara,MN Medikal Nobel,2005:295-302.
- McPhee SJ,Papadakis MA,Lawrence M,Tierney JR. Hyperparathyroidism.Current Medical Diagnosis & Treatment 46.ed.Mc Graw Hill. 2007: 1173-1179.
- Koppel M H., Shinaberger J H, Massry S G et al. Hypercalcemic response to hydrochlorothiazide in üremia: Evidence for external effect on calcium metabolizm. Annals of ınternal Medicine, 1970;72(5): 803.
- Sato K, Hasegawa Y, Hydrochlorothiazide Ef- fectively Reduces Urinary Calcium Excretion in two Japanese patients with Gain of Function Mutations of the Calcium –Sensing Receptor Gene The J.of Clinical Endocrinology & Metabolism 2002;Vol.87, No.7 3068-3073.
- Hakim R, Tolis G,Goltzman D. et al Severe hy- percalcemia associated with hydrochlorothiazide and calcim carbonate therapy. Can. Med Assoc J. 1979;121(5): 591-594.
- Carrol MF, Schade DS. A practical approch to the Hypercalcemia, AM. Family Physician, 2003; 67(9): 1959-1966.
- Ariyan CE, Sosa JA. Assessment and management of patients with abnormal calcium. Crit Care Med. 2004;32(4 Suppl):S146-150.
Abstract
Kanda kalsiyum seviyesinin normal sınırlarından yüksek olması durumunda hiperkalsemiden bahsedilir.Genellikle belirti olmadan tesadüfi olarak başka hastalıklar nedeniyle yapılan kan ölçümlerinde fark edilir. Maligniteler ve primer hiperparatiroidi ,hiperkalsemilerin %90 sebebini oluştururken, geriye kalan nedenler D vitamini ;A vitamini entoksikasyonu, thiazid grubu diüretikler, theophyllin,lityum gibi ilaçlar ve diğer nedenlerdir.Bu yazımızda 82 yaşında kadın hastada kalsiyum seviyesi 15,9mg/dl bulunması nedeniyle hidrasyon,diüretik tedaviyle cevap alınamadı. Pamidronat tedavisi ile hiperkalsemi düzeltildi.Bu sırada hiperkalsemi sebepleri gözden geçirildi.Hastanın antihipertansif olarak kullandığı hidroklorotiazidin yaşa bağlı immobilizasyonla birleşince hiperkalsemiye sebep olduğu düşünüldü.İleri yaşta hidroklorotiazid tedavisi ile birlikte Kalsiyum preparatlarının alınması immobilizasyonla birleşince Parathormon baskılanması ile hiperkalsemi ‘ye sebep olabilir.
Keywords
References
- Uysal A.R. Primer Hiperparatiroidizm ve Hip- erkalsemi, Sekonder Hiperparatiroidizm. Erdoğan G. Koloğlu Endokrinoloji Temel ve Klinik,2.baskı,Ankara,MN Medikal Nobel,2005:295-302.
- McPhee SJ,Papadakis MA,Lawrence M,Tierney JR. Hyperparathyroidism.Current Medical Diagnosis & Treatment 46.ed.Mc Graw Hill. 2007: 1173-1179.
- Koppel M H., Shinaberger J H, Massry S G et al. Hypercalcemic response to hydrochlorothiazide in üremia: Evidence for external effect on calcium metabolizm. Annals of ınternal Medicine, 1970;72(5): 803.
- Sato K, Hasegawa Y, Hydrochlorothiazide Ef- fectively Reduces Urinary Calcium Excretion in two Japanese patients with Gain of Function Mutations of the Calcium –Sensing Receptor Gene The J.of Clinical Endocrinology & Metabolism 2002;Vol.87, No.7 3068-3073.
- Hakim R, Tolis G,Goltzman D. et al Severe hy- percalcemia associated with hydrochlorothiazide and calcim carbonate therapy. Can. Med Assoc J. 1979;121(5): 591-594.
- Carrol MF, Schade DS. A practical approch to the Hypercalcemia, AM. Family Physician, 2003; 67(9): 1959-1966.
- Ariyan CE, Sosa JA. Assessment and management of patients with abnormal calcium. Crit Care Med. 2004;32(4 Suppl):S146-150.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | April 1, 2009 |
| Published in Issue | Year 2009 Volume: 1 Issue: 1 |