Hiperkalsemi ve Çoklu Patolojik Kemik Fraktürü ile Başvuran Akut Lenfoblastik Lösemi

Hiperkalsemi,  bazı lenfoproliferatif hastalıklarda sıkça görülmesine rağmen çocukluk çağı akut lenfoblastik lösemilerinde nadir bir komplikasyondur. Bu yazıda hiperkalsemi ve çoğul patolojik kemik kırıkları ile başvuran ve akut lösemi tanısı konulan 8 yaşında bir erkek olgu sunulmuştur. Hiperkalsemi etkeni olabilecek tüm nedenler araştırıldı ve laboratuar testler normal bulundu. Hiperkalsemi, intravenöz izotonik sodyum klorür, furosemid, steroidler ve bifosfonatlar ile tedavi edildi. Hiperkalsemi, çocukluk çağı akut lenfoblastik löseminin başlangıç laboratuvar bulgusu olabilir. Tekrarlayan laboratuvar ve periferik yayma incelemeleri hiperkalseminin ayırıcı tanısında önemlidir.

Hiperkalsemi ve Çoklu Patolojik Kemik Fraktürü ile Başvuran Akut Lenfoblastik Lösemi

Hypercalcemia is common in some lymphoproliferative disorders, but is a rare complication of acute lymphoblastic leukemia in childhood. We report a 8-year-old boy who presented with hypercalcemia and multiple pathologic bone fracture was diagnosed to have acute lymphoblastic leukemia. All the disorders that could be the reason of hypercalcemia and the laboratory tests were within normal limits. Hypercalcemia was treated with intravenous isotonic sodium chloride solution, furosemide and biphosphonates. Hypercalcemia may be a presenting laboratory finding of acute lymphoblastic leukemia in childhood. Repeat laboratory and peripheral blood smear examinations are important for differential diagnosis of hypercalcemia.

___

  • Referans 1. McCauley LK, Martin TJ. Twenty-five years of PTHrP progress: from cancer hormone to multifunctional cytokine. J Bone Miner Res. 2012;27(6):1231-9. Referans 2.Makras P, Papapoulos SE. Medical treatment of hypercalcaemia. Hormones (Athens). 2009 ;8(2):83-95. Referans 3. Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr. 2010;22(4):508-15. Referans 4. Çelik E, Özdemir GN, Tüysüz G, Taştan Y, Çam H, Celkan T. A child presenting with hypercalcemia. Turk Pediatri Ars. 2014 Mar 1;49(1):81-3. Referans 5. Shimonodan H, Nagayama J, Nagatoshi Y, Hatanaka M, Takada A, Iguchi H, et al. Acute lymphocytic leukemia in adolescence with multiple osteolytic lesions and hypercalcemia mediated by lymphoblast-producing parathyroid hormone-related peptide: a case report and review of the literature. Pediatr Blood Cancer. 2005;45(3):333-9. Referans 6. Trehan A, Cheetham T, Bailey S. Hypercalcemia in acute lymphoblastic leukemia: an overview. J Pediatr Hematol Oncol. 2009;31(6):424-7. Referans 7. Inukai T, Hirose K, Inaba T, Kurosawa H, Hama A, Inada H, et al. Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19. Leukemia. 2007;21(2):288-96. Referans 8. Türker M, Oren H, Yilmaz S, Cakmakçi H, Demircioglu F, Irken G. Unusual presentation of childhood acute lymphoblastic leukemia: a case presenting with hypercalcemia symptoms only. J Pediatr Hematol Oncol. 2004;26(2):116-7. Referans 9. Ganesan P, Thulkar S, Gupta R, Bakhshi S. Childhood aleukemic leukemia with hypercalcemia and bone lesions mimicking metabolic bone disease. J Pediatr Endocrinol Metab. 2009;22(5):463-7. Referans 10. Body JJ, Bartl R, Burckhardt P, Delmas PD, Diel IJ, Fleisch H, et al. Current use of bisphosphonates in oncology. International Bone and Cancer Study Group. J Clin Oncol. 1998;16(12):3890-9.