HIPERKALSEMIA ADALAH PDF
;46(2) 17] Key words: Bisphosphonate, hypercalcemia of malignancy, rehydration Hiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran. ;46(2)–17] Key words: Bisphosphonate, hypercalcemia of malignancy, rehydration Hiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran. ;46(2)–17]. Key words: Bisphosphonate, hypercalcemia of malignancy, rehydration. Hiperkalsemia pada Keganasan: Karakteristik.
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Hasan Sadikin General Hospital Abstract Hypercalcemia is one of the most common paraneoplastic syndromes in hospitalized malignancy patients. The aim of this study was to determine the clinical characteristics and treatment outcome in hypercalcemia of malignancy.
This was a study using medical records of patients with adalha hospitalized in the Departement of Internal Medicine, Dr. There were 40 patients with hypercalcemia of malignancy, consisted of 22 hematologic malignancies and 18 solid tumors.
Disturbance of consiousness were found in 4, dehydration in 18, constipation in 6, and nausea and vomiting in hiperkalsemis subjects.
In 16 subjects, no symptoms were found. All subjects received rehydration with normal saline. Bisphosphonate was given in 26 subjects. The difference of decreasing ion calcium level, between hiperkalsenia groups who were treated with or without bisphosphonate was 0. Treatment either with or without bisphosphonate shows good results. Bisphosphonate, hypercalcemia of malignancy, rehydration Hiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran Terapi Abstrak Hiperkalsemia merupakan salah satu sindrom paraneoplasma yang sering ditemukan pada pasien keganasan.
Tujuan penelitian ini untuk mengetahui karakteristik klinis dan respons terapi penderita dengan hiperkalsemia pada keganasan. Dari 40 penderita dengan hiperkalsemia pada keganasan, didapatkan 22 keganasan hematologi dan 18 tumor padat. Gejala klinis yang ditemukan adalah gangguan kesadaran pada 4 subjek, dehidrasi pada 18 subjek, hiperkalsenia pada 6 subjek, mual dan muntah pada 6 subjek.
Pada 16 subjek tidak ditemukan gejala.
Hiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran Terapi – PDF
Dua puluh enam hierkalsemia mendapat terapi bisfosfonat. Simpulan, qdalah keganasan penyebab hiperkalsemia hampir sama antara keganasan hematologi dan tumor padat. Bisfosfonat, hiperkalsemia pada keganasan, rehidrasi Correspondence: While focal osteolysis in metastasis sites is the most common skeletal manifestation of cancer, systemic effects such as hypercalcaemia or diffuse osteopenia are also common. Neoplasma can alter calcium homeostasis indirectly through the production of endocrine factors hkperkalsemia in humoral hypercalcemia of malignancy.
The mechanisms that are thought to be important during the development of hypercalcemia include bone-resorbing cytokines; parathyroid hormonerelated peptide secreted by the tumor that binds to parathyroid hormone receptors; tumor-mediated calcitriol production; and, occasionally, ectopic parathyroid hormone secretion. In addition, hypercalcemia is one of the more common paraneoplastic syndromes.
As a paraneoplastic syndrome, HCM is commonly seen in association with multiple myeloma MM and breast, lung, renal and ovarian neoplasms.
Hasan Sadikin Hospital Bandung.
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The aim of this study was to obtain information about the clinical characteristics and treatment outcome in hypercalcemia of malignancy. This study results could be used to improve recognition and management of the hypercalcemia of malignancy.
Methods This is a study using medical record of patients with malignancy who were hospitalized at the Departement of Internal Medicine, Dr. Adalwh Sadikin Hospital Bandung during the period of December March Inclusion criteria were age above 14 years old, had hematologic malignancy or solid tumor confirmed through histopathologic analysis.
Patients with acute or chronic renal failure, granulomatous disorders, adrenal insuffuciency, and thyrotoxicosis as well as hiperkaalsemia with thiazides consumption were not eligible for this study.
The data was presented as frequency and median. The ionized calcium level before and 1 day after bisphosphonate treatment was analyzed. The difference between ion calcium level before and after treatment was calculated by Wilcoxon test.
The difference in the changes of ion calcium between subjects treated with biophosphonate and those who did not receive bisphosphonate was calculated by Mann Whitney test. Results There were 40 subjects with hypercalcemia of malignancy, consisted of 22 with hematologic malignancies and 18 with solid tumors.
Among subjects with hematologic malignancies, 15 were found with malignant lymphoma, followed by seven subjects with myeloma multiple. Among all solid tumors, most were found in the breast, followed by lung, head and neck cancer, i. Prostate, pancreas and renal cell carcinomas were found in 1 subject for each cancer type.
The changes in ion calcium level before and after treatment were available in 29 subjects Table 3. The difference in the decreasing ion calcium level between the group who received bisphosphonate and not was 0.
Among 11 subjects with life threatening HCM, no symptom was found in 4, dehydration was found in 3, loss of consciousness in 2 and constipation in 1 subject. There was no cardiac arrest in all our subjects. Among 16 subjects without symptoms, we found mild, severe and life threatening HCM in 8, 4 and 4 subjects, respectively. Hypercalcemia leads to a progressive mental impairment, which include coma, as well as renal failure.
Among the hematologic malignancy, malignant lymphoma was found in fifteen subjects, followed by seven subjects with Table 2 Clinical Manifestation of Hypercalcemia Clinical Manifestations n No symptom 16 Disturbance of 4 consiousness Dehydration 18 Constipation 6 Nausea and vomiting 6 myeloma multiple. Our result was about the same as the previous report. It occurs in patients with both solid tumors and hematologic malignancies.
The most common cancers associated with hypercalcemia are breast and lung cancer and multiple myeloma. Prostate, pancreas and renal cell carcinomas were found in one subject for each cancer type. Hypercalcemia of malignancy is rare in patients with prostate cancer. Patients with HCM may present with wide range of symptoms, but the development and severity of symptoms do not appear to be strictly correlated with the serum calcium levels.
The rapidity of onset is more likely to correlate with the symptom severity rather than the degree of hypercalcemia. Recognition of the early symptoms of HCM is vital because, if left untreated, it can progress rapidly and may become severe of life threatening. Progression of HCM can be prevented with apropriate measures, including hydration, anticancer therapy, and treatment with bisphosphonates.
Our results showed wide variety of symptoms and HCM level. These results were consistent with the previous study that reported HCM may present with wide range of symptoms but the development and severity of symptoms do not appear to be strictly correlated with serum calcium levels.
However, cure is frequently not possible and in patients with symptomatic or life threatening hypercalcemia, therapy must be aimed specifically againts the mediating mechanisms.
The presence of increased osteoclastic bone resorption is seen in essentially every patient with HCM and, therefore, a key target for treatment and prevention of hypercalcemia. Two of these mechanisms in particular, increased osteoclastic bone resorption and increased renal tubular calcium reabsorption, are common to most patients with HCM, even though those cases not associated with parathyroid hormone related peptide PTHrP production.
Medical therapy is, therefore, aimed at inhibiting bone resorption and promoting renal calcium excretion. Normal level of calcium ion: The dehydration leads to a reduction in the glomerular filtration rate that further reduces the ability of the kidney to excrete the excess serum calcium.
First, therefore, parenteral volume expansion should be initiated, with the administration of normal saline. These factors must be assessed with the use of careful clinical monitoring for physical finding that are consistent with fluid overload.
The goals of treatment are to increase the glomerular filtration rate that will increase the filtered load of calcium which passes through the glomerulus into the tubular lumen and to inhibit calcium reabsorption in the proximal nephron because saline itself is calciuretic. These agents may exacerbate fluid loss; therefore, their use should be limited to the volume repleted patient and only then with close monitoring of volume status.
Hydration alone rarely results in full resolution of hypercalcemia, however and more aggresive therapies are usually needed. They have an affinity for bone surfaces undergoing active resorption and are released in the bone microenvirontment during remodelling. Bisphosphonate compounds can be divided into two distinct pharmacological classes with different mechanisms of action depending on whether they contain a nitrogen atom in their side chains of non-nitrogen-containing bisphosphonates, which are the first generation bisphosphonates, that include etidronate and clodronate, are metabolized intracellularly to cytotoxic, non-hydrolyzable analogs of adenosine triphosphate ATP that may inhibit ATPdependent intracellular enzymes in osteoclasts.
The nitrogen-containing bisphosphonates, which are second or third generation bisphosphonates that include pamidronate, alendronate, and ibandronate, inhibit protein prenylation which leads to loss of membrane localization of small G proteins such as Ras, Rho and Rac. Consequently, osteoclasts may undergo apoptosis. Zoledronic acid is superior to pamidronat for the treatment of HCM with 4 mg as the recommended dose im the initial treatment of HCM and 8 mg for relapsed of refractory HCM In continental Europe, the United Kingdom and other countries, ibandronate and clodronate are also widely used.
Due to financial problem, all patients could not received zoledronic acid and received clodronic acid instead. We had calcium ion level data before and after treatment in 29 subjects. All subjects had decreased ion calcium level after treatment. The ion calcium level in subjects received bisphosphonate before and after treatment were 7.
The ion calcium level in subjects who did not received bisphosphonate was 6. The difference of decreasing ion calcium level between subjects who received bisphosphonate and nor was 0. In these circumstances, dialysis with dialysate containing litle or no calcium is a reasonable and highly effective option for selected patient. The definite treatment chemotherapy was given in 15 subjects. In conclusion, the malignancy causing hypercalcemia was about the same proportion between hematologic and solid tumor.
Among hematologic malignancy, malignant lymphoma followed by myeloma multiple.
Hiperkalsemia pada Keganasan: Karakteristik Klinik dan Luaran Terapi
Among solid tumor, the most frequent one was breast cancer followed by lung cancer and head and neck cancer.
Disturbance of consiousness, dehydration, constipation, nausea and vomiting were found. Treatment either with hiprrkalsemia or normal saline rehydration alone gave good result. Hypercalcemia of malignancy and basic research on mechanisms responsible for osteolytic and osteblastic metastasis to bone.
J Am Soc Nephrol. Hypercalcemia of malignancy in hospitalized patients. A practical approach to hypercalcemia. N Engl J Med. McMahan J, Linneman T. A case of resistant hypercalcemia of malignancy with a proposed treatment algorithm. Systemic therapy for bone metastases. Mechanism and treatment of hypercalcemia of malignancy. Curr Opin Endocrinol Diabetes Obes. MKB, Volume 46 No. Treatment of oncologic emergencies. Makras P, Papapoulos SE. Medical treatment of hypercalcaemia.