another cause of hypercalcemia

Welcome new clerks!!

I hope you will have a chance to look at the attachments here to complement your exposure at the hospial.


We started off this week with a case of serious hypercalcemia (3.78!!, normal albumin)  that was managed with fluids, pamidronate, calcitriol .. and was still high in the morning.
See the previous post on hypercalcemia HERE.

Along with the : CALCIUM,
there was RENAL FAILURE, ANEMIA, BONY PAIN.
thus very suggestive of Multiple myeloma. 

Multiple Myeloma is a hematologic malignancy that arises from a single clone of plasma cells producing a monoclonal immunoglobulin (usually IgG or IgA). 

A lot of the clinical features arise from the proliferation of these cells, and the immunoglobulins which are released.

Renal disease: there are MANY causes such as: 1) light chain or cast nephropathy,  2)amyloidosis, 3)light chain deposition disease, 4)Fanconi’s syndrome (proximal tubular dysfunction), and 5)hypercalcemia with acute renal failure. Less commonly, one might see 6)heavy chain deposition disease, 7)cryoglobulinemia, 8)uric acid nephropathy and 9)renal plasma cell invasion.

Anemia:  due to plasma cells proliferating, displacing the normal bone marrow. 

Bone Pain: secondary to lytic lesions or pathologic fractures. (increased osteoclast and decreased osteoblast activity because of cytokine RANKL)

Recurrent Infection: secondary to hypogammaglobulinemia and impaired plasma cell function. (most commonly: Pneumonia and pyelonephritis)

For more information, here is a Review on MM.