Elevated Serum Calcium Levels Research Articles

Pre-Transplant Calcimimetic Use and Dose Information Improves the Accuracy of Prediction of Tertiary Hyperparathyroidism after Kidney Transplantation: A Retrospective Cohort Study.

Tertiary hyperparathyroidism (THPT) is characterized by elevated parathyroid hormone and serum calcium levels after kidney transplantation (KTx). To ascertain whether pre-transplant calcimimetic use and dose information would improve THPT prediction accuracy, this retrospective cohort study evaluated patients who underwent KTx between 2010 and 2022. The primary outcome was the development of clinically relevant THPT. Logistic regression analysis was used to evaluate pre-transplant calcimimetic use as a determinant of THPT development. Participants were categorized into four groups according to calcimimetic dose, developing two THPT prediction models (with or without calcimimetic information). Continuous net reclassification improvement (CNRI) and integrated discrimination improvement (IDI) were calculated to assess ability to reclassify the degree of THPT risk by adding pre-transplant calcimimetic information. Of the 554 patients, 87 (15.7%) developed THPT, whereas 139 (25.1%) received pre-transplant calcimimetic treatment. Multivariate logistic regression analysis revealed that pre-transplant calcimimetic use was significantly associated with THPT development. Pre-transplant calcimimetic information significantly improved the predicted probability accuracy of THPT (CNRI and IDI were 0.91 [p < 0.001], and 0.09 [p < 0.001], respectively). The THPT prediction model including pre-transplant calcimimetic information as a predictive factor can contribute to the prevention and early treatment of THPT in the era of calcimimetics.

Preclinical development of EXT608, an investigational parathyroid hormone derivative with extended half-life for the treatment of hypoparathyroidism.

Hypoparathyroidism, a deficiency of parathyroid hormone (PTH), results in hypocalcemia, hyperphosphatemia, and hypercalciuria. The disease is poorly controlled by calcium and vitamin D supplements or native PTH(1-84) replacement therapy. A version of PTH is being developed using D-VITylation technology, whereby vitamin D is conjugated to a therapeutic peptide, which confers a long plasma half-life by virtue of binding to the abundant vitamin D binding protein (DBP). D-VITylation of PTH caused no reduction in activity at the PTHR1 receptor, and resulted in a plasma elimination half-life of 7-15h in rats and 24-32h in cynomolgus monkeys. Analysis of steady-state pharmacokinetics as a function of dose showed flat profiles with smaller peak:trough ratios at low doses, indicative of slower subcutaneous absorption. In thyroparathyroidectomized (TPTx) rats, PTH(1-34)-vitamin D conjugates restored serum calcium and phosphate levels into the normal range over the 24h dosing period, and increased bone turnover markers and reduced bone mineral density. Urinary calcium was initially elevated, but normalized by the end of treatment on day 27. In healthy monkeys, a single dose of PTH(1-34)-vitamin D conjugates elevated serum calcium levels above the normal range for a period of 24-48h while simultaneously reducing urinary calcium. Therefore, the lead compound, EXT608, is a promising candidate as a therapeutic that can truly mimic the endogenous activity of PTH and warrants further study in patients with hypoparathyroidism.

Association between thymic hyperplasia and serum calcium level in Graves’ disease

BackgroundGraves' disease increases bone resorption in hyperthyroidism, leading to elevated serum calcium levels and a negative bone balance. Thymic hyperplasia is observed in some Graves' disease patients. What's more, there have been a few reports of increased serum calcium and severe osteoporosis induced by Graves’ disease with thymic hyperplasia. It remains unclear whether Graves’ disease with thymic hyperplasia is associated with higher serum calcium levels. Our study aimed to investigate the possibility of elevated serum calcium levels and aggravated bone mobilization in Graves’ disease patients with thymic hyperplasia.MethodsNewly diagnosed and untreated patients with Graves' disease (n = 96) were enrolled. They were divided into two groups based on the incidental detection of thymic hyperplasia during imaging. Albumin, alkaline phosphatase, calcium, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, and thyrotrophin receptor antibody (TRAb) were measured, and a computerized tomography of the chest was obtained.ResultsPatients with Graves’ disease who had thymic hyperplasia were notably younger (P=0.018) and exhibited higher serum calcium levels (P=0.001) compared to those with Graves’ disease without thymic hyperplasia. In the multiple regression analysis, thymic hyperplasia, TRAb, and female gender were significant variables associated with elevated serum calcium levels in patients with Graves' disease, collectively accounting for 31.7% of the variation in serum calcium.ConclusionsGraves’ disease patients with thymic hyperplasia showed higher serum calcium levels. thymic hyperplasia, TRAb, and female gender were found to be correlated with increased serum calcium levels in Graves’ disease, suggesting a potential association between thymic hyperplasia and bone mobilization in Graves’ disease.

An Ectopic Parathyroid Adenoma of the Retropharynx in a Patient with Primary Hyperparathyroidism and Papillary Thyroid Cancer-A Rare Case.

The frequency of concurrent thyroid cancer in patients with primary hyperparathyroidism (pHPT) varies. While the pathological association between thyroid and parathyroid disorders is frequently noted, the co-occurrence of parathyroid adenoma and papillary thyroid cancer is exceptionally rare. Furthermore, an ectopic parathyroid adenoma in the retropharyngeal space is exceedingly rare. Therefore, anatomical variations through the utilization of relevant diagnostic tools play a crucial role in guiding decisions pertaining to clinical manifestations, diagnostic methods, surgical interventions, and operative strategies for parathyroid tumors. We present a case of a 51-year-old female patient with papillary thyroid carcinoma in the right thyroid lobe and an ectopic parathyroid adenoma in the retropharyngeal space confirmed through surgical intervention. The elevated preoperative levels of serum calcium and parathyroid hormone, along with low serum phosphate, returned to normal ranges after surgery. This case sheds light on the unusual occurrence of an ectopic parathyroid adenoma in the retropharyngeal region within a thyroid cancer patient, providing valuable insights into the realm of thyroid malignancies.

Rare manifestations of sarcoidosis in a young boy

Sarcoidosis is a chronic multisystem granulomatous disease of unknown etiology. It is rare in young children. A 9-year-old boy presented with failure to thrive, skin rashes, persistent fever and respiratory symptoms since 5 years of age. Blood investigations done showed elevated serum calcium and angiotensin converting enzyme (ACE) levels and biopsy of the rashes on the left shin revealed non-caseating granulomatous lesion. Computed tomography (CT) of chest revealed interstitial lung disease (ILD) and examination of eyes showed bilateral uveitis. He also had sensorineural hearing impairment, nephrocalcinosis and short stature. The patient was treated with oral steroids and mycophenolate mofetil. At follow up there was improvement in his systemic features including rashes and arthritis. Early detection, diagnosis and appropriate treatment of sarcoidosis are vital for disease control and to avoid morbidity.

Urinary tract infection triggering hypercalcemic crisis in an asymptomatic patient with primary hyperparathyroidism

Hypercalcemic crisis (HC) is a rare and severe complication of primary hyperparathyroidism (PHPT), characterized by markedly elevated serum calcium levels and diverse clinical manifestations. PHPT is the primary cause of hypercalcemia and is often asymptomatic. The factors that trigger HC in PHPT are not fully understood. Here we report a patient who was diagnosed with HC resulting from previously undetected PHPT. Remarkably, the patient exhibited no symptoms of PHPT before the HC episode. The patient presented with neurological symptoms, including altered behavior and slurred speech, which were attributed to hypercalcemia. The probable trigger for HC in this case appears to be an acute febrile illness related to a urinary tract infection (UTI). The occurrence of an acute febrile illness or UTI as a precipitating factor for HC in PHPT is a rare and infrequently documented phenomenon in the existing medical literature.

A Novel Adult Case of Recurrent Acute Pancreatitis Caused by Hypercalcemia With Concurrent Manifestation of Posterior Reversible Encephalopathy Syndrome Revealing Undiagnosed Primary Hyperparathyroidism due to an Underlying Parathyroid Adenoma.

Hypercalcemia-induced posterior reversible encephalopathy syndrome (PRES) is a rare entity primarily associated with iatrogenic vitamin D/calcium overdose, malignancy, or, infrequently, primary hyperparathyroidism. We present a novel case of an adult male from rural India who experienced recurrent acute pancreatitis caused by hypercalcemia with concurrent manifestation of PRES. Diagnostic evaluation revealed markedly elevated serum calcium levels and parathyroid hormone concentrations, consistent with primary hyperparathyroidism. Imaging studies identified a parathyroid adenoma near the right thyroid lobe, subsequently surgically excised. This case underscores the importance of considering primary hyperparathyroidism as an underlying cause of PRES, especially in the absence of acute arterial hypertension or autonomic dysfunction. Early recognition and intervention are essential in mitigating the morbidity and mortality of PRES.

Valproic acid monitoring: Serum prediction using a machine learning framework from multicenter real-world data

BackgroundOur study employs machine learning to predict serum valproic acid (VPA) concentrations, aiming to contribute to the development of non-invasive assays for therapeutic drug monitoring. MethodsMedical records from 2002 to 2019 were obtained from the Taiwan Chang Gung Research Database. Using various machine learning algorithms, we developed predictive models to classify serum VPA concentrations into two categories (1–50 μg/ml or 51–100 μg/ml) and predicted the exact concentration value. The models were trained on 5142 samples and tested on 644 independent samples. Accuracy was the main metric used to evaluate model performance, with a tolerance of 20 μg/ml for continuous variables. Furthermore, we identified important features and developed simplified models with fewer features. ResultsThe models achieved an average accuracy of 0.80–0.86 for binary outcomes and 0.72–0.88 for continuous outcome. Ten top features associated with higher serum VPA levels included higher VPA last and daily doses, bipolar disorder or schizophrenia spectrum disorder diagnoses, elevated levels of serum albumin, calcium, and creatinine, low platelet count, low percentage of segmented white blood cells, and low red cell distribution width-coefficient of variation. The simplified models had an average accuracy of 0.82–0.86 for binary outcome and 0.70–0.86 for continuous outcome. LimitationsThe study's predictive model lacked external test data from outside the hospital for validation. ConclusionsMachine learning models have the potential to integrate real-world data and predict VPA concentrations, providing a promising tool for reducing the need for frequent monitoring of serum levels in clinical practice.

Clinical Profile and Outcomes of Patients With Hypercalcemia in an Indian Tertiary Care Center.

Hypercalcemia is a complex medical condition characterized by elevated levels of serum calcium (>10.5 mg/dL) in the bloodstream, often arising from various underlying etiologies. This condition presents a significant clinical challenge due to its diverse clinical manifestations and potential for serious complications. Profiling and understanding hypercalcemia is essential for accurate diagnosis, appropriate management, and improved patient outcomes. In this study, we delve into the comprehensive profiling of hypercalcemia, encompassing its epidemiology, pathophysiology, clinical presentation, and diagnostic approaches. We explore the multifaceted etiological factors contributing to hypercalcemia, including primary hyperparathyroidism, malignancies, granulomatous disorders, medications, and more. We highlight the intricate interplay between parathyroid hormone, vitamin D, and other regulatory mechanisms that influence calcium homeostasis, shedding light on the underlying molecular pathways. Furthermore, we discuss the diverse clinical manifestations of hypercalcemia, ranging from asymptomatic cases to severe, life-threatening complications involving the renal, gastrointestinal, cardiovascular, and neuromuscular systems. Accurate diagnosis is pivotal, and we evaluate the array of laboratory tests, imaging modalities, and specialized assays that aid in identifying the root cause of hypercalcemia. We emphasize the importance of a systematic approach to differential diagnosis and the significance of risk stratification to guide clinical decision-making. The evolving landscape of treatment options for hypercalcemia is also explored, encompassing both acute management and long-term strategies tailored to the underlying etiology. We assess the role of hydration, pharmacological agents, and surgical interventions, underscoring the need for individualized therapeutic plans based on the severity and underlying cause of hypercalcemia. In conclusion, the profiling of hypercalcemia is a multidimensional endeavor that necessitates a comprehensive understanding of its underlying mechanisms, diverse clinical presentations, and diagnostic intricacies. This study intends to serveas a valuable resource for healthcare professionals, offering insights into the complex terrain of hypercalcemia.

Unraveling the Mysteries of Hypercalcemic Encephalopathy: A Clinical Experience from A Tertiary Care Center.

Background Hypercalcemic encephalopathy is a rare but clinically significant condition characterized by a range of complex symptoms due to elevated serum calcium levels. The causes of this condition can stem from various underlying factors, with the most common being primary hyperparathyroidism, malignancies, and granulomatous diseases. This study aims to provide a comprehensive clinical profile of hypercalcemic encephalopathy by examining a cohort of patients presenting at a tertiary care center. Results We analyzed etiologies, clinical manifestations, and short-term outcomes in 32 patients with a mean age of 32.45 years. The study revealed that malignancy-related hypercalcemia was the predominant cause in a significant portion of the cases (46.8%), indicating that cancer-associated mechanisms play a substantial role in the development of hypercalcemic encephalopathy. Hyperparathyroidism, accounted for 34.3% of the cases, followed by granulomatous disease, which was the underlying factor in 12.5% of the cases. Unfortunately, six patients experienced mortality during the study. The primary reasons for these unfortunate outcomes were related to hypercalcemia itself, highlighting critical importance of its proper management. Conclusion The treatment responses observed in the study provided valuable insights. About 37.5% of the patients responded positively to the administration of intravenous fluids and calcitonin, a hormone involved in calcium regulation. However, for those who did not respond to these standard treatments, the introduction of denosumab, a medication that inhibits bone resorption and can lower calcium levels, yielded positive outcomes. This suggests the potential utility of denosumab in cases where traditional treatments are ineffective. Overall, this study significantly contributes to our understanding of hypercalcemic encephalopathy by delving into its clinical features, the range of underlying causes, responses to treatment, and patient outcomes. The findings underscore the importance of recognizing this condition promptly and implementing tailored interventions to ensure optimal management and improved patient care

Challenges in the Diagnosis of Parathyroid Cancer: Unraveling the Diagnostic Maze

Parathyroid carcinoma (PC) is a rare and aggressive cancer affecting the parathyroid glands, presenting diagnostic and therapeutic challenges due to its rarity and overlapping features with benign parathyroid disease. This report describes the case of a 51-year-old patient with significantly elevated serum calcium levels, leading to further investigation. Imaging studies revealed a large nodular mass in the right inferior parathyroid gland. After undergoing right inferior parathyroidectomy, pathology confirmed parathyroid carcinoma. However, the patient experienced a relapse, detected via a neck MRI. This case highlights the importance of specific clinical features, such as rapid calcium increase, elevated parathyroid hormone (PTH) levels, and a large nodular mass, in suspecting malignancy. Differential diagnosis between carcinoma and adenoma can be challenging, and immunohistochemistry aids in diagnosis. Regular follow-up with calcium and PTH monitoring is essential for detecting recurrence. This case underscores the aggressive nature of parathyroid carcinoma and the importance of early diagnosis, surgical intervention, and thorough follow-up care for improved outcomes.

A case of right parathyroid adenoma and its management

A 33 year old female patient presented with history of body and joint pain with easy fatiguability unable to perform her routine daily activities since 2 months. She also gave history of recurrent urinary tract infections, pain abdomen, loss of appetite and loss of weight. Examination of neck showed no palpable mass. Laboratory data revealed elevated serum calcium levels and parathyroid hormone levels. Contrast enhanced computed tomography of neck showed well-defined soft tissue density lesion measuring 2.6×1.9×1.6 cm in the postero inferior aspect of right lobe of thyroid suggestive of right parathyroid adenoma. Parathyroid imaging (SPECT) 99mTc-MIBI showed focal increased tracer uptake in relation to inferior aspect of right lobe of thyroid gland. NCCT KUB showed bilateral non obstructive renal calculi with medullary nephrocalcinosis. Patient underwent surgical resection under general anesthesia and histopathology confirmed parathyroid adenoma. Following surgery, parathyroid hormone and calcium levels gradually returned to normal levels. Parathyroid adenoma shows excellent prognosis with complete surgical resection.

Vitamin D deficiency linked to abnormal bone and lipid metabolism predicts high-risk multiple myeloma with poorer prognosis.

Vitamin D deficiency is frequent in patients with multiple myeloma (MM), however, its prognostic relevance in MM was rather inconclusive. We first investigated the association of vitamin D deficiency with abnormal bone and lipid metabolism in newly diagnosed multiple myeloma (NDMM), and next assessed the impact of serum ratio of vitamin D to carboxy-terminal telopeptide of type I collagen (β-CTX) on progression-free survival (PFS) and overall free survival (OS) in patients with NDMM. The data of 431 consecutive patients with NDMM at Beijing Jishuitan Hospital from September 2013 to December 2022 were collected and retrospectively reviewed through our electronic medical record system. The measurement of 25-hydroxyvitamin D in the blood is an indicator of an individual's overall vitamin D status. The serum levels of vitamin D were negatively correlated with β-CTX in NDMM patients. Of note, positive correlation between vitamin D and cholesterol levels in the serum was found in this study. The cohort (n = 431) was divided into two groups based on the serum ratio of vitamin D to β-CTX. Compared to the group with a higher vitamin D to β-CTX ratio, the group with a lower vitamin D to β-CTX ratio (n = 257, 60%) exhibited hypocholesterolemia, inferior PFS and OS, along with increased cases of ISS stage-III and R-ISS stage-III, a higher number of plasma cells in the bone marrow, and elevated serum calcium levels. Consistent with this, multivariate analysis confirmed that the vitamin D to β-CTX ratio was an independent unfavorable indicator for survival in NDMM patients. Our data demonstrated the ratio of vitamin D to β-CTX in the serum is a unique biomarker for NDMM patients to identify the high-risk cases with poor prognosis, which is superior to vitamin D itself for predicting PFS and OS in NDMM. Also, it is worth mentioning that our data on the connection between vitamin D deficiency and hypocholesterolemia might help clarify novel mechanistic aspects of myeloma development.

AN INTERESTING CASE OF KNOCK KNEE

Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of parathyroid hormone. The manifestations may be subtle, and the disease may have a benign course for many years or a lifetime. If the patients are symptomatic , the most commonly involved system include the renal and the skeletal system. Herein we present a case of 16 year old male who presented with complaints of multiple large joint pain and progressive deformity of both knees over the past 1 year. Physical examination revealed bilateral genu valgum. Investigations taken showed elevated serum calcium levels, parathormone levels, alkaline phosphatase levels and low levels of vitamin D. Skeletal radiograph taken showed evidence of osteitis brosa cystica along with salt and pepper appearance of the skull. USG Neck showed evidence of left parathyroid adenoma and a Tc99 Sestamibi parathyroid scintigraphy scan conrmed it. Patient underwent inferior parathyroidectomy. Post procedure, patient's parathormone levels were within the normal limits and hence was discharged with calcium and vitamin D supplements.

Paraneoplastic Hypercalcaemia as a Cause of Unexplained Renal Impairment in a Patient With Seminoma: A Case Report

A 44-year-old otherwise healthy male who had undergone left high inguinal orchidectomy, with histopathology suggestive of classical seminoma, was referred to the authors’ oncology centre for evaluation of persistently deranged renal function tests and initiation of chemotherapy. They had a large retroperitoneal mass encasing their left kidney and their creatinine was 4.2 mg/dL. Even 1 week after double J stenting, they had persistently elevated creatinine of 3.1 mg/dL, which was precluding their curative chemotherapy with bleomycin/cisplatin/etoposide regimen. In a desperate situation, to prevent further progression of disease, pre-phase chemotherapy with carboplatin and etoposide was considered. In anticipation of tumour lysis syndrome, considering the large mass and compromised renal function, a tumour lysis profile was requested, which revealed elevated serum calcium levels (15.4 mg/dL, which goes against the tumour lysis syndrome). Considering the large retroperitoneal lymph nodal mass, suppressed parathyroid hormone levels (4.1 pg/mL) and vitamin D3 being within normal range, a paraneoplastic cause of hypercalcaemia was considered. Correction of hypercalcaemia with medical measures as well as treatment of seminoma was instituted, which led to normalisation of renal function tests within the next 10 days. Here, the authors report a rare case of testicular seminoma with persistently deranged renal function, likely due to paraneoplastic hypercalcaemia, which improved after successful chemotherapy along with anti-hypercalcaemic measures, including aggressive hydration, diuretics, calcitonin, dexamethasone, and denosumab. This report shows that it is important to treat the cause along with medical management in this oncologic metabolic emergency. It also highlights the value of pre-phase chemotherapy with carboplatin and etoposide in the setting of acute renal impairment.

Serum Calcium, 25-Hydroxyvitamin D, and Parathyroid Hormone Levels in Relation to Aneurysmal Subarachnoid Hemorrhage.

Elevated serum calcium (S-Ca), 25-hydroxyvitamin D (S-25OHD), and parathyroid hormone (S-PTH) levels have been associated with risk of aneurysmal subarachnoid hemorrhage (SAH) in observational studies. However, whether these associations are causal is unclear. The objective of the present study was to determine whether genetically predicted S-Ca, S-25OHD, and S-PTH levels are causally associated with aneurysmal SAH using a Mendelian randomization design. Analyses were performed using summary-level data for genetic variants associated with S-Ca, S-25OHD, and S-PTH concentrations. Summary data for aneurysmal SAH were adopted from a genome-wide association study (GWAS) on intracranial aneurysm (n = 79,429 individuals, 69% of the cases had aneurysmal SAH). The inverse variance-weighted approach was adopted as the primary analyses. For sensitivity analyses, the weighted median and MR-Egger approaches were adopted. Genetically predicted S-Ca and S-PTH levels were associated with aneurysmal SAH in the primary analyses. The odds ratios (ORs) of aneurysmal SAH were 1.96 (95% CI: 1.003-3.812; P = 0.049) and 1.495 (95% CI: 1.058-2.114; P = 0.023) for one SD increase of genetically predicted S-Ca and S-PTH levels, respectively. Genetically predicted S-25OHD concentration was not associated with aneurysmal SAH (per 1 SD increase in S-25OHD: OR = 0.92; 95% CI, 0.78-1.09; P = 0.332). Sensitivity analysis yielded similar results, and no evidence of pleiotropy was observed. Our results indicated that higher genetically predicted S-Ca and S-PTH levels may increase the risk of aneurysmal SAH.

Parathyroid carcinoma: impact of preoperative diagnosis on the choice of surgical procedure.

The operative procedure in the surgical treatment of parathyroid carcinoma differs from that of benign hyperparathyroidism. However, preoperative differentiation is often difficult. This study elucidated how clinicians diagnose parathyroid carcinoma and the relationship between preoperative diagnosis and the operative course. Using a retrospective chart review, twenty cases of parathyroid carcinoma from nine participating centers were examined. In 11 cases with preoperative suspicion of malignancy, at least one of these three features was found: elevated serum calcium level (>14 mg/dL), palpable mass, and irregular margin on ultrasonography. Although an intact parathyroid hormone (iPTH) threshold to suspect malignancy has not been established, six cases showed marked iPTH elevation exceeding 8.0 times the upper limit of normal. One case was excluded from analysis due to hemodialysis. Compared with the four cases that showed calcium elevation, the iPTH threshold might represent better sensitivity. Among 9 cases of benign preoperative diagnosis, six cases were performed with pericapsular resection. In three cases where malignancy was suspected in the middle of the operation, the recommended en bloc resection with ipsilateral thyroid lobectomy was not performed but a parathyroidectomy with surrounding soft tissue. In contrast, 10 preoperatively suspected cases underwent en bloc resection, and one case underwent pericapsular resection followed by supplementary ipsilateral hemithyroidectomy due to the uncertain pre- and intraoperative findings to determine the diagnosis. In conclusion, the surgical procedure for parathyroid carcinoma strongly depends on the preoperative diagnosis. The presence of excessive iPTH levels might contribute to improved preoperative diagnostic sensitivity for parathyroid carcinoma.

Serum Calcium, Magnesium and Creactive protein levels in female Metabolic Syndrome patients

Background: Metabolic syndrome (Mets) is a risk factor for cardiovascular, chronic lung, liver and kidney diseases. Hypercalcaemia, hypomagnesaemia and elevated C-reactive protein (CRP) produce various complications such as cardiac arrythmia, renal stones, atherosclerosis, Diabetes Mellitus, Obesity etc. Some researchers suggested that hypercalcaemia, hypomagnesaemia and elevated CRP occur in Metabolic syndrome patients. Objectives: To measure serum calcium, magnesium and CRP levels in Metabolic syndrome patients. Methods: This cross sectional study was conducted from March 2019 to July 2020 in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University(BSMMU), Shahbag, Dhaka. For this study, 30 female metabolic syndrome patients aged 25 to 45 year, from the Outpatient department of Endocrinology of BSMMU were selected. For comparison, 30 age and gender matched apparently healthy female subjects were control. Serum calcium and magnesium were measured by Colorimetric method and serum CRP was measured by Immunoturbidimetric method. Independent sample‘t’ test was performed for serum calcium and Mann-Whitney U test was performed for serum magnesium and CRP. Results: Mean serum calcium (p £0.05 and median value of serum CRP (p £0.01) were significantly higher, median value of serum magnesium was lower (p&gt;0.05) but not significant in Metabolic syndrome patients than that of control. Conclusion: This study may conclude that elevated serum calcium and CRP levels are associated with metabolic syndrome patients. J Bangladesh Soc Physiol. 2022, June; 17(1): 14-20

Utility of angiotensin-converting enzyme and serum calcium levels in cutaneous sarcoidosis.

Sarcoidosis is a granulomatous disease of unknown etiology but is theorized to result from immune overactivity in the setting of an environmental or genetic trigger. It most commonly affects the lungs and lymph nodes but can affect other organ systems, with cutaneous involvement in 30% of patients. The granulomas associated with sarcoidosis lead to increased activity of angiotensin-converting enzyme (ACE) and 1α-hydroxylase resulting in an uncontrolled synthesis of 1,25-dihydroxyvitamin D3 by macrophages, along with elevated serum ACE and calcium levels. Serum ACE and calcium levels are frequently ordered when a patient is diagnosed with cutaneous sarcoidosis. However, their clinical utility in this setting remains unknown. In this retrospective chart review, we assessed serum ACE and calcium levels in 19 patients with cutaneous sarcoidosis diagnosed by histopathology without preceding evidence of systemic involvement. Serum ACE and calcium levels were also investigated as markers in the progression from mono-organ cutaneous sarcoidosis to systemic sarcoidosis. No patients with biopsy-proven cutaneous sarcoidosis had abnormal levels of serum calcium at presentation in a cohort of 17 patients at a single institution. An abnormally elevated ACE level was only seen in one of 13 patients presenting with cutaneous sarcoidosis. Our data suggest that serum ACE and calcium levels are not reliable markers of either cutaneous sarcoidosis or the progression to systemic sarcoidosis.

Two-way Road of Kidney and Hypercalcemia: A Narrative Review.

Calcium homeostasis is regulated by the dyad of parathyroid hormone and calcitriol, whereas kidney, intestine, and bone are the primary target sites. Elevation of serum calcium levels and hypercalcemia are likely markers of pathological conditions, particularly malignancy and hyperparathyroidism. Similarly, several dysfunctions within the body can direct hypercalcemia. Furthermore, chemicals and drugs can also drive this condition. Owing to the significant role of the kidney in calcium homeostasis, renal abnormalities lead to hypercalcemia and increased calcium levels can have pathological effects on the kidney. This review is designed to highlight some of the commonly known causes of hypercalcemia and their effects on the kidney.