Hüseyin KARAASLAN, Tevfik SABUNCU, Mehmet Nuri TURAN, Mehmet Ali EREN

Hayatı Tehdit Eden Hiperkalsemi ile Başvuran Hipoparatiroidizmli Hasta

Süt-alkali sendromu ilk olarak peptik ülser hastalığı nedeniyle kalsiyum içeren antiasitleri yüksek dozda kullanan hastalarda tanımlanmıştır. Hiperkalsemi, metabolik alkaloz ve akut böbrek yetmezliği üçlemesinden oluşmaktadır. Sendromun modern ülser tedavilerinin geliştirilişiyle azalan görülme sıklığı, günümüzde osteoporoz ve renal osteodistrofi nedeniyle kalsiyum kullanımına bağlı olarak yeniden artmaya başlamıştır. Bu sunumda idiyopatik hipoparatiroidizm nedeniyle kalsiyum karbonat ve aktif D vitamini tedavisi altında iken kliniğimize hayatı tehdit eden hiperkalsemi, metabolik alkaloz ve akut böbrek yetmezliği tablosu ile başvuran bir hastayı anlatmaktayız

Life-threatening Hypercalcemia in a Patient with Hypoparathyroidism

Milk-alkali syndrome was first described in patients using high dose antacid drugs for peptic ulcer. The triad of the syndrome is hypercalcemia, metabolic alkalosis, and acute renal failure. The incidence of the syndrome that decreased after the development of modern ulcer treatments has currently been increasing again due to the use of calcium-containing medicine for osteoporosis and renal osteodystrophy. In this report, we present a patient who had been under calcium carbonate and active vitamin D treatment due to idiopathic hypoparathyroidism and presented with life-threatening hypercalcemia, metabolic alkalosis, and acute renal failure

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1. Beall DP, Hensiee HB, Webb HR, Scofield RH. MilkAlkali syndrome: a historical review and description of the modern version of the syndrome. Am J Med Sci. 2006;331:233–42.
2. Krysiak R, Handzlik-Orlik G, Okopien B. Humoral hypercalcemia of malignancy in a patient with hypoparathyroidism. Eur Rev Med Pharmacol Sci. 2012;16(8):1127–9
3. De Rosa G, Testa A, Giacomini D, Liverotti J, Salvi G, Cefaro GA. Alternation of hypo- and hypercalcemia in a parathyroidectomized patient with breast cancer. Horm Res. 1995;43(5):210–2.
4. Sundaresh V, Levine SN. From hypocalcemia to hypercalcemia: an unusual clinical presentation of a patient with permanent postsurgical hypoparathyroidism. J Clin Endocrinol Metab. 2015;100(1):21–4.
5. Kondo S, Tamura K, Makino S, Yokota T, Ishikawa E, Katakami H ve ark. A patient with primary hypoparathyroidism developing hypercalcemia associated with adult T-cell leukemia/lymphoma. Leuk Lymphoma. 1994;14(5–6):521–5.
6. Mitchell TH, Stamp TC, Jenkins MV, Mawer EB, Berry JL. Hypercalcaemic sarcoidosis in hypoparathyroidism. Br Med J (Clin Res Ed). 1983;286(6367):764–5.
7. Dockrell DH, Poland GA. Hypercalcemia in a patient with hypoparathyroidism and Nocardiaa steroides infection: a novel observation. Mayo Clin Proc. 1997;72(8):757–60.
8. Ito O, Kohzuki M, Nakajima I, Sato K, Nomura T, Kudo K ve ark. Thiazide-induced hypercalcemic nephropathy in a patient with secondary hypoparathyroidism. Nihon Naika Gakkai Zasshi. 2004;93(7):1448–50.
9. Hepburn NC, Abdul-Aziz LA, Whiteoak R. Danazol-induced hypercalcaemia in alphacalcidol-treated hypoparathyroidism. Postgrad Med J. 1989;65(769):849–50.
10. Schroth M, Dötsch J, Dörr HG. Hypercalcemia and idiopathic hypoparathyroidism. J Clin Pharm Ther. 2001;26(6):453–5.
11. Boots JM, Burghouts JT, Jansen JL. Unaccountable severe hypercalcemia in a patient treated for hypoparathyroidism with dihydrotachysterol. Neth J Med. 1999;54(1):16–20.
12. Caplan RH, Beguin EA. Hypercalcemia in a calcitrioltreated hypoparathyroid woman during lactation. Obstet Gynecol. 1990;76(3 Pt 2):485–9.
13. Caplan RH, Wickus GG. Reduced calcitriol requirements for treating hypoparathyroidism during lactation. A case report. J Reprod Med. 1993;38(11):914–8.
14. Cathébras P, Cartry O, Sassolas G, Rousset H. Hypercalcemia induced by lactation in 2 patients with treated hypoparathyroidism. Rev Med Interne.1996;17(8):675–6.
15. Walker DA, Davies M. Addison’s disease presenting as a hypercalcemic crisis in a patient with idiopathic hypoparathyroidism. Clin Endocrinol (Oxf). 1981;14(4):419– 23.
16. Verbeelen D, Fuss M. Hypercalcaemia induced by oestrogen withdrawal in vitamin D-treated hypoparathyroidism. Br Med J. 1979;1(6162):522–3.
17. Felsenfeld AJ, Levine BS. Milk alkali syndrome and the dynamics of calcium homeostasis. Clin J Am Soc Nephrol. 2006;1:641–54.
18. Satoh F, Okado T, Iwamoto M, Akita W, Wakabayashi M, Ohta A ve ark. Calcium-alkali syndrome-like symptoms manifested by daily alphacalcidol and thiazide. Intern Med. 2010;49:837–40.
19. Etiology of hypercalcemia. Erişim: https://www.uptodate.com/contents/etiology-of-hypercalcemia.