pyrophosphate and Hypercalcemia

Topics: Calcium Pyrophosphate; Chondrocalcinosis; Crystallization; Diphosphates; Humans; Hypercalcemia; Synovial Fluid

Topics: Animals; Calcium; Cholecalciferol; Diphosphates; Glomerular Filtration Rate; Humans; Hydroxycholecalciferols; Hypercalcemia; Kidney Failure, Chronic; Mitochondria, Liver; Parathyroid Glands; Parathyroid Hormone; Phosphates; Rats

Topics: Acidosis, Renal Tubular; Bacterial Infections; Citrates; Crystallization; Cystinuria; Diphosphates; Female; Gastrointestinal Diseases; Humans; Hypercalcemia; Hyperparathyroidism; Magnesium; Male; Metabolism, Inborn Errors; Mucoproteins; Oxalates; Quaternary Ammonium Compounds; Sarcoidosis; Solubility; Uric Acid; Urinary Calculi; Vitamin D; Xanthine Oxidase

Four sequential Tc-99m pyrophosphate (PYP) imaging studies were performed in a 28-year-old man with high fever and exudate pharyngitis associated with renal failure. Radiotracer localization in the left ventricle (LV), lungs, kidneys, and skeletal muscles were seen in two, initial imaging studies. In the second and third imaging studies, area of increase in activity was seen in the left-sided bowel. In studies done two months later (in the third study), the radioactivity in the skeletal muscles was no longer seen. Studies obtained nine months (in the fourth study) after the first imaging showed less radiotracer localization in the LV, lungs, and kidneys as compared to that seen in the initial study. Myocardial necrosis and microcalcification were proved by LV biopsy. The exact mechanism of extraosseous bone-imaging agent localization is unknown. However, this phenomenon may be related to renal failure, rhabdomyolysis, hypercalcemia, hyperphosphatemia, or elevated parathyroid hormone. The Tc-99m PYP imaging study is useful and sensitive in the detection of extraosseous tissue calcification and monitoring of the disease process.

Topics: Acute Kidney Injury; Adult; Diphosphates; Humans; Hypercalcemia; Male; Phosphates; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate

A case of severe hypercalcemia due to metastases to bone from a primary breast cancer is presented. The different drugs available for treating hypercalcemia are described, and the rationale for their use is discussed.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diphosphates; Drug Therapy, Combination; Female; Humans; Hypercalcemia; Middle Aged; Plicamycin

Patients with rhabdomyolysis (RBD) and acute renal failure (ARF) are hypocalcemic during the oliguric phase of ARF and over 30% develop hypercalcemia during the diuretic phase. The present study examined the factors underlying these derangements in calcium metabolism in 15 patients: 7 with RBD and ARF, 4 with RBD only, and 4 with ARF only. All patients had hypocalcemia on admission and the hypocalcemia was more pronounced in those with RBD and ARF. All patients with RBD independent of the presence or absence of ARF had calcium deposition in soft tissues as documented by technetium-99 scan. In 4 patients with RBD and ARF, hypercalcemia developed during the diuretic phase at a time when Serum PTH levels were undetectable. Only patients with RBD and ARF had a significant increase in serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D [1,25(OH)2D] during the diuretic phase and both the increments in and the levels of 1,25(OH)2D were significantly greater in those who were hypercalcemic. The data indicate that 1) hypocalcemia occurs in RBD independent of ARF and is most likely related to calcium deposition in injured tissues, and 2) elevation in serum levels of 1,25(OH)2D plays an important role in the genesis of hypercalcemia during the diuretic phase of patients with RBD and ARF. Our observations suggest that extrarenal production of 1,25(OH)2D may occur in these patients, and/or that the renal production of 1,25(OH)2D may not be so tightly controlled as it is in normal subjects.

Topics: Acute Kidney Injury; Adult; Calcinosis; Calcitriol; Diphosphates; Diuresis; Female; Humans; Hypercalcemia; Hypocalcemia; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Metastatic soft tissue calcification is known to occur in hypercalcemia and is usually present in the kidneys, stomach and lungs. 1--3 This case presents two unusual features: 1) ectopic parathormone production in association with poorly differentiated lymphocytic lymphoma; and and 2) uptake of 99mTc-pyrophosphate in the liver in the absence of demonstrable abnormality at autopsy. The more usual sites of metastatic calcification also showed uptake of the radionuclide. We will discuss metastatic soft tissue calcification, ectopic parathyroid hormone production, hypercalcemia in malignancy and bone scan agent localization in soft tissues.

Topics: Aged; Bone Neoplasms; Calcinosis; Diphosphates; Female; Hormones, Ectopic; Humans; Hypercalcemia; Liver; Lymphoma, Non-Hodgkin; Neoplasm Metastasis; Parathyroid Hormone; Radionuclide Imaging; Technetium

The inorganic constituents and crystalline features of extraosseous calcium-phosphate deposits obtained from dialyzed uremic and hypercalcemic patients were studied. Visceral calcification (heart, lung, and kidney) in hypercalcemic patients exhibited either an amorphous or apatitic X-ray diffraction pattern. Uremic visceral calcification consistently gave an amorphous diffraction pattern. Although the calcium content of uremic and hypercalcemic visceral deposits was similar, other inorganic constituents were different. The mean pyrophosphate was 11 +/- 11.8 and magnesium 4.91 +/- 3.86 mg/g in the uremic group as compared to 0.92 +/- 0.24 and 1.36 +/- 1.26 mg/g in the hypercalcemic group (P less than 0.025). After incineration hypercalcemic visceral deposits having an amorphous diffraction pattern were found to generate pyrophosphate supporting the presence of brushite in these deposits. The small amount of pyrophosphate in apatitic deposits from both uremic and hypercalcemic patients actually decreased after incineration and the pyrophosphate content of uremic visceral deposits was unchanged by incineration. It is concluded that in hypercalcemic patients the initial visceral deposit is brushite which is subsequently transformed to apatite. Arterial and tumoral calcium-phosphate deposits in uremic patients were also apatite. Uremic visceral calcium-phosphate deposits are an unique mineral high in magnesium with approximately 30% of the phosphorus present as pyrophosphate. The high pyrophosphate content of these deposits could alter their crystalline structure and prevent the transformation to apatite. The infrared features, high magnesium content of the deposit, and resistance of pyrophosphate in the deposit to hydrolysis by pyrophosphatase suggests that the pyrophosphate may be deposited as the magnesium salt.

Topics: Apatites; Calcinosis; Calcium; Calcium Phosphates; Chemical Phenomena; Chemistry; Diphosphates; Humans; Hypercalcemia; Magnesium; Uremia; X-Ray Diffraction

Topics: Animals; Aorta, Thoracic; Aortic Diseases; Calcinosis; Cholecalciferol; Diphosphates; Female; Hypercalcemia; Kidney; Phosphates; Rats

Topics: Animals; Aortic Diseases; Bone Resorption; Calcinosis; Calcium Phosphates; Chemical Phenomena; Chemical Precipitation; Chemistry; Cholecalciferol; Diphosphates; Hypercalcemia; Mice; Organophosphonates; Pyrophosphatases; Rats

Topics: Animals; Calcinosis; Calcium; Dihydrotachysterol; Diphosphates; Female; Hypercalcemia; Parathyroid Hormone; Rats; Skin