A successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia

Published on Jun 30, 2016in Annals of Pediatric Endocrinology & Metabolism
路 DOI :10.6065/APEM.2016.21.2.99
Hye Jin Park7
Estimated H-index: 7
(DCU: Catholic University of Daegu),
Eun Jin Choi7
Estimated H-index: 7
(DCU: Catholic University of Daegu),
Jin-Kyung Kim27
Estimated H-index: 27
(DCU: Catholic University of Daegu)
Sources
Abstract
Severe hypercalcemia in children is a rare medical emergency. We present a case of a 15-year-old boy with hypercalcemia (total calcium level, 14.2 mg/dL) with a normal complete blood count, no circulating blasts in the peripheral blood film, and no other signs of acute lymphoblastic leukemia (ALL), including no signs of lymphadenopathy or hepatosplenomegaly. The hypercalcemia was successfully treated with zoledronic acid. As hypercalcemia can be the only presenting symptom of ALL in children, the diagnosis is often delayed. In children presenting with hypercalcemia, malignancies must be considered in the differential diagnosis.
馃摉 Papers frequently viewed together
References20
Newest
#1Hillel Sternlicht (Cornell University)H-Index: 5
#2Ilya G. Glezerman (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 18
Hypercalcemia of malignancy affects up to one in five cancer patients during the course of their disease. It is associated with both liquid malignancies, commonly multiple myeloma, leukemia, and non-Hodgkins lymphoma and solid cancers, particularly breast and renal carcinomas as well as squamous cell carcinomas of any organ. The clinical manifestations of hypercalcemia are generally constitutional in nature and not specific to the inciting malignancy. Such physical manifestations can range from ...
Source
Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with...
Source
Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, i...
Source
#1Sobenna GeorgeH-Index: 1
#2David R. Weber (UR: University of Rochester)H-Index: 19
Last. Michael A. Levine (UPenn: University of Pennsylvania)H-Index: 88
view all 6 authors...
Context: Zoledronic acid (ZA) is increasingly used in young patients with bone disorders. However, data related to the safety of ZA administration in this population are limited. Objective: The study aimed to characterize the short-term safety profile of ZA and identify risk factors for ZA-related adverse events (AEs) in young patients. Design, Setting, and Participants: This was a retrospective chart review of inpatients and outpatients less than 21 years old who received at least one ZA infusi...
Source
#1Rajitha LokadasanH-Index: 3
#2Shruti PremH-Index: 6
Last. A. V. JayasudhaH-Index: 2
view all 4 authors...
Acute lymphoblastic leukaemia (ALL) presenting with hypercalcaemia and lytic bone lesions is a rare event in children unlike adults. We report a 15-year-old boy with acute lymphoblastic leukaemia and hypercalcaemia. He had normal peripheral blood count and the peripheral smear did not show blast. The bone marrow examination revealed Pre B ALL phenotype with aberrant expression of CD13. The skeletal survey showed osteolytic lesions. Hypercalcaemia was treated with zoledronic acid. He attained rem...
Source
: Hypercalcemia is rare in children with etiology different from adults. We report an 11.5-year-old boy with developmental delay that presented with difficulty in walking and vomiting. Laboratory investigations revealed hypercalcemia (Ca 13.8 mg/dL) with low serum parathormone, normal full blood count and no circulating blasts. Osteolytic lesions were discovered on radiological survey. Bone marrow examination was consistent with the diagnosis of common B acute lymphoblastic leukemia (ALL). Hyper...
Source
Bisphosphonates are widely used for the prevention and treatment of osteoporosis in adulthood. In the last years, bisphosphonates have been increasingly used in pediatric patients for the treatment of a growing number of disorders associated with osteoporosis, resistant hypercalcemia or heterotopic calcifications. The use of bisphosphonates in pediatric patients has been proven safe; however, the risk of potential severe consequences into adulthood should be kept in mind. Well-defined criteria f...
Source
PTHrP was identified as a cause of hypercalcemia in cancer patients 25 yr ago. In the intervening years, we have learned that PTHrP and PTH are encoded by related genes that are part of a larger 鈥淧TH gene family.鈥 This evolutionary relationship permits them to bind to the same type 1 PTH/PTHrP receptor, which explains why humoral hypercalcemia of malignancy resembles hyperparathyroidism. This review will outline basic facts about PTHrP biology and its normal physiological functions, with an emph...
Source
Hypercalcaemia is a far less common finding in children than in adults. It may present with characteristic symptoms or may be identified as a coincidental finding in children investigated for a variety of complaints. Assessment of hypercalcaemia requires an understanding of the normal physiological regulation of plasma calcium by the combined actions of parathyroid hormone, 1,25-dihydroxyvitamin D3 and the calcium sensing receptor. Hypercalcaemia will usually require treatment using a number of ...
Source
Cited By11
Newest
#1Wei-Ping ChenH-Index: 1
#2Wen-Fang ChiangH-Index: 3
Last. Po-Jen Hsiao (NDMC: National Defense Medical Center)H-Index: 1
view all 5 authors...
Acute lymphoblastic leukaemia (ALL) is diagnosed by the presence of at least 20% lymphoblasts in the bone marrow. ALL may be aggressive and include the lymph nodes, liver, spleen, central nervous system (CNS), and other organs. Without early recognition and timely treatment, ALL will progress quickly and may have poor prognosis in clinical scenarios. ALL is a rare type of leukaemia in adults but is the most common type in children. Precipitating factors such as environmental radiation or chemica...
Source
#1Mark Kilbane (UCD: University College Dublin)H-Index: 13
#2Rachel K CrowleyH-Index: 17
Last. Patrick J TwomeyH-Index: 24
view all 5 authors...
Parathyroid hormone-related protein (PTHrP) can simulate most of the actions of parathyroid hormone (PTH) including increases in bone resorption and distal tubular calcium reabsorption and inhibition of proximal tubular phosphate transport.1 The low serum phosphate in parallel with low circulating PTH is consistent with PTHrP involvement in this case. Whether it can be causative for a serum calcium of 6.24 mmol/L however is a moot point. While the mechanism underlying the patient鈥檚 severe hyperc...
Source
Abstract Disorders of calcium, magnesium, and phosphate metabolism and of bone formation, accrual, and maintenance during the first 2 decades of life result from suboptimal ingestion, absorption, or retention of constituent nutrients; abnormal vitamin D metabolism or bioactivity; disorders of parathyroid hormone synthesis, secretion, or action; and intrinsic aberrations in cartilage and bone cells. The origins of these illnesses may be intrinsic because of pathological variations in the genes co...
Source
#1Qiang Lin (Boston Children's Hospital)H-Index: 1
#2Yanhong Li (Boston Children's Hospital)H-Index: 1
Last. Xiaozhong Li (Soochow University (Suzhou))H-Index: 3
view all 8 authors...
Source
#1Emanuela ChiarellaH-Index: 11
#2Bruna CodispotiH-Index: 11
Last. Heather M. BondH-Index: 15
view all 10 authors...
Abstract A leukemic in vitro model produced by transducing Cord Blood derived-hematopoietic CD34+ cells with the MLL-AF9 translocation resulting in the oncogenic fusion protein, is used to assess for sensitivity to Zoledronic acid. These cells are practically immortalized and are of myeloid origin. Proliferation, clonogenic and stromal co-culture assays showed that the MLL-AF9 cells were considerably more sensitive to Zoledronic acid than normal hematopoietic CD34+ cells or MS-5 stromal cells. T...
Source
#1Chantel CacciottiH-Index: 3
#2Brian Leber (HHS: Hamilton Health Sciences)H-Index: 60
Last. Uma H. AthaleH-Index: 31
view all 6 authors...
Hand mirror cell (HMC) leukemia is a variant of acute lymphoblastic leukemia previously described in the adult population where lymphoblasts manifest distinctive hand mirror morphologic features. HMC has been previously identified in 23% of childhood acute lymphoblastic leukemia patients, but its pr
Source
#1S. V. Papizh (RSMU: Russian National Research Medical University)H-Index: 1
Hypercalcemia is a result of a wide range of hereditary and acquired conditions encountered by general physicians and pediatricians. Calcium participates in several key physiological functions, control of blood coagulation, bone calcification. Calcium homeostasis is tightly regulated by the interplay between absorption from the small intestine and renal tubular reabsorption, bone remodeling, and disposal through the gut and the kidney. These processes are regulated by local and circulating facto...
Source
#1Madalina BotaH-Index: 3
#2Gheorghe PopaH-Index: 4
Last. Cristina BlagH-Index: 4
view all 5 authors...
: BACKGROUND Malignant hypercalcemia is a rare finding in the pediatric population, even more rare in hematological malignancies, such as leukemia. CASE REPORT We present a case of a 6-year-old female patient who was diagnosed with acute lymphoblastic leukemia, with secondary hypercalcemia. She started chemotherapy following the IC-BFM ALL2002 protocol with simultaneous calcitonin, diuretics and aggressive hydration for hypercalcemia, and went into complete remission after the induction therapy....
Source
#1Ari Auron (UMKC: University of Missouri鈥揔ansas City)H-Index: 5
#2Uri Alon (UMKC: University of Missouri鈥揔ansas City)H-Index: 102
Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etio...
Source
#1Victoria Stokes (University of Oxford)H-Index: 6
#2Morten F Nielsen (University of Oxford)H-Index: 1
Last. Rajesh V. Thakker (University of Oxford)H-Index: 96
view all 4 authors...
: Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean, which in children may vary with age and sex, reflecting changes in the normal physiology at each developmental stage. Hypercalcemic disorders in children may present with hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, polyuria, dehydration, failure to thrive, and seizures. In severe cases renal failure, pancreatitis and reduced consciousness ...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.