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Nathan Goodyear

Rare Occurrence of 3 "H": Hypercalcemia, Hemolytic Anemia and Hodgkin's Lymphoma - 0 views

www.ncbi.nlm.nih.gov/...PMC4925562

Hodgkin's lymphoma Hodgkin's disease hypercalcemia lymphoma

shared by Nathan Goodyear on 21 Aug 18 - No Cached
  • administered zoledronic acid (4 mg). Prednisolone (1 mg/kg/day) was started and simultaneously, she was administered first cycle of ABVD (Adriamycin: 25 mg/m2, Bleomycin: 10 U/m2, Vinblastine: 6 mg/m2 and Dacarbazine: 375 mg/m2), which led to normalisation of serum calcium levels over 4 days and improvement in her hemoglobin levels
  • Etiology of anemia in Hodgkin’s lymphoma is multifactorial. Anemia of chronic disease, decreased red cell survival, infiltration of bone marrow by tumor and marrow suppression by chemotherapy/radiotherapy are the common mechanisms
  • Our case had only a transient response to steroids and chemotherapy. Therefore, she was treated with Rituximab which brought hemolysis under control
  • ...7 more annotations...
  • Mechanism of hypercalcemia in HL has long been suggested to involve extra-renal activation of 1α-hydroxylase leading to production of 1, 25(OD)2 Vitamin D3 or Calcitriol, an active metabolite of Vitamin D, which leads to increased re-absorption of calcium and phosphate from intestine, increased osteoclast activation and bone resorption as well as increased phosphate re-absorption in renal tubules
  • Hypercalcemia of malignancy involves three mechanisms: 1. Humoral hypercalcemia mediated by PTHrP—seen in solid tumors like breast cancer and adult T cell leukemia/lymphoma (ATLL), 2. Direct osteoclast mediated bone resorption due to bony metastasis—seen in solid tumors and multiple myeloma, 3. Calcitriol mediated hypercalcemia—seen in Hodgkin’s and non-Hodgkin’s lymphoma as well as granulomatous disorders like tuberculosis, sarcoidosis, leprosy and disseminated Candidiasis
  • Hypercalcemia in HL is rare and its incidence has been reported as 0.9, 1.6 and 5.4 % in different series
  • The source of 1α-hydroxylase in HL has been postulated as monocytes and macrophages infiltrating the tumor akin to tuberculosis or sarcoidosis and is stimulated by IFN-γ secreted by T-lymphocytes
  • Like sarcoidosis, patients with HL exhibit increased sensitivity to Vitamin D supplements and sunlight, which have been found to precipitate hypercalcemia in these patients
  • Classical biochemical profile in Calcitriol mediated hypercalcemia include: an elevated calcium, normal/slightly elevated phosphate, normal 25(OH) Vitamin D, suppressed PTHrP and PTH, elevated Calcitriol and a normal/increased tubular reabsorption of phosphate
  • not been associated with a poorer prognosis and tends to subside after treatment of the underlying disease
  • Nathan Goodyear on 21 Aug 18
     
    great read on hypercalcemia in hodgkin's lymphoma.
Nathan Goodyear

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2819900501%2963%3A9%3C1700%3A... - 0 views

onlinelibrary.wiley.com/...NCR2820630910%3E3.0.CO%3B2-%23

Hodgkin's lymphoma non-hodgkin's lymphoma lymphoma sarcoidosis vitamin D calcitriol hypercalcemia calcium

shared by Nathan Goodyear on 21 Aug 18 - No Cached
  • Nathan Goodyear on 21 Aug 18
     
    Hodgkin's and non-Hodgkin's lymphoma increase calcitriol production (1,25) similar to sarcoidosis.  This can lead to hypercalcemia.  This is a case study.
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