Both acute and severe hypercalcemia should be regarded as life-threatening emergencies with a significant mortality risk; patients invariably require hospitalization and urgent therapeutic intervention. Primary hyperparathyroidism and malignancy-associated hypercalcemia are the two most frequent clinical situations in which severe hypercalcemia may develop. Symptoms of hypercalcemia, which vary among patients, are related to several factors, such as the absolute concentration and the rate of rise in serum calcium, the age of the patient, and comorbidities. The clinical manifestations reflect disturbances in central nervous system, gastrointestinal, renal, and cardiovascular function. Intravenous hydration, bisphosphonates, and calcitonin are all first-line therapies. In patients with hypercalcemia due to exogenous or endogenous vitamin D intoxication, glucocorticoids can be very effective. Finally, in cases of life-threatening hypercalcemia, when other approaches have not been successful, dialysis may be necessary. If the life-threatening hypercalcemia is due to a parathyroid crisis, urgent parathyroidectomy may be indicated after the patient has been stabilized.

Acute Management of Hypercalcemia

Summary We present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness. Coronary angiography and other visualization methods were normal. Implantable cardioverter-defibrillator (ICD) implantation was planned for the purpose of secondary prevention of sudden cardiac death (SCD). Laboratory and hormonal analyzes revealed primary hyperparathyroidism (PHPT), chronic kidney disease, and hypokalemia. Neck ultrasound showed a 25 mm, sharply outlined homogenous tumor mass which was separated from thyroid gland (TG) and exerted a mild impression on lower parts of the left lobe. Dual wash technetium-99m sestamibi parathyroid scintigraphy with single-photon emission CT (SPECT)/CT also showed the uptake of tracer behind the lower half of the left lobe of the TG. Surgical treatment, lower left parathyroidectomy, was performed, and pathohistological analysis verified parathyroid adenoma. The patient was rhythmically and hemodynamically stable for 7 days after surgery, without additional complaints, and was discharged from the hospital. Timely diagnosis of PHPT, correct assessment and surgical treatment, did not lead our patient to unnecessary ICD implantation. Our case suggests an additional intertwining of electrolyte disorders and ventricular arrhythmias in PHPT and more importantly emphasizes the need for caution when indicating ICD, even in patients with the most serious life-threatening arrhythmias. Learning points Electrolyte abnormalities in PHPT can have highly malignant consequences, and the occurrence of hypokalemia in the presence of hypercalcemia is underestimated in PHPT, and the consequences can be life-threatening. Although hypercalcemia causes shortened QT interval, concomitant severe hypokalemia may overcome hypercalcemia and prolong QT interval, even in the absence of structural heart disease or LQTS. Timely diagnosis of PHPT, correct assessment and surgical treatment, do not lead to unnecessary ICD implantation.

/pdf/primary-hyperparathyroidism-associated-with-acquired-long-qt-568d1s8xql.pdf

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia.

__________________________________________________________________________________________ Purpose: This study reports the clinical profile of children with abnormalities of the corpus callosum in magnetic resonance imaging (MRI). Materials and methods: Children with agenesis of the corpus callosum (ACC), hypoplasia, and dysgenesis were identified in a database of patients at the Department of Pediatric Radiology. Medical records were then systematically reviewed. Twenty brain MRI scans of children with abnormalities of the corpus callosum were chosen randomly and retrospectively analyzed. We also analyzed age, gender, motor development, mental development, epilepsy, and concomitant disorders. Results: The study group was composed of 20 children with various disorders (11 girls, 9 boys). The ages of the children ranged from 4 months to 17 years, with a mean age of 9.8 years. Almost all children were born at term. More than half of patients 11(55%) had ACC, 6 children had hypoplasia of the corpus callosum hypoplasia and 3 patients had an absence of genu of the corpus callosum or splenium. Nine children had mental retardation. Four patients had hydrocephalus and two had meningomyelocele, while two patients had Dandy-Walker syndrome and one had holoprosencephaly. Three patients had headache. One patient had tics syndrome and one Attention deficithyperactivity disorder. Fifteen children had normal motor development, with three using a wheelchair, and two unable to sit and walk. Three patients had epilepsy. Conclusion: A spectrum of clinical presentations is apparent in children with abnormalities of the corpus callosum.

Abnormalities of the corpus callosum: Magnetic resonance imaging analysis in children

Acute Myocardial Infarction Mimicking Squamous Cell Lung Cancer with Bone Metastases Due to Hypercalcemia: a Case Report.

Long QT interval in severe hypercalcaemia.

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Long QT interval in severe hypercalcaemia.