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Prague, Czech Republic

Hypercalcemia associated with breast cancer arises either from metastatic bone disease or from paraneoplastic secretion of parathyroid hormone-related peptide. We report a female 69-year-old patient with invasive intraductal breast cancer and hypercalcemia (3,4 mmol/l) referred to endocrinologist. Standard care in oncology was refused and with respect to the presence of estrogenic receptors the patient accepted only antiestrogenic treatment. Bone scan revealed no skeletal metastasis. Entry laboratory exam confirmed hypercalcemia, hypophosphatemia and significantly elevated parathyroid hormone (793 ng/l). The patient complained of bone pain and dyspepsia. Neck ultrasound showed a multinodular goiter with particularly enlarged left lobe. Parathyroid gland scintigraphy revealed a possible parathyroid adenoma behind the lower pole of the left thyroid lobe. The patient underwent thyroidectomy with an excision of the parathyroid mass. Microscopic examination identified a benign adenomatous goitre and benign parathyroid adenoma. Postoperatively, both serum calcium and parathyroid hormone normalized. Replacement of calcium and vitamin D were initiated both with bisphosphonate with regard to newly diagnosed osteoporosis. This case demonstrates a patient with breast cancer and hypercalcemia unrelated to the malignant disease. Primary hyperparathyroidism should be considered as a possible cause of hypercalcemia in breast cancer patients in the setting of negative bone scan, elevated parathyroid hormone and mildly deteriorated bone mineral density.

Zofkova I.,Endokrinologicky Ustav
Interni Medicina pro Praxi | Year: 2012

In this review foundamental physiological and pathophysiological aspects of clacaemia regulation are mentioned. Syptomatology, consequences and treatment of hypercalcaemia, incl. hypercalcaemic cisis, are discussed. Attention is focused on primary hyperparathyroidism, which is, together with malignant diseases, the most frequent cause of hypercalcaemia (90 %). In diferential diagnosis malignant and granulomatous diseases, renal failure, endocrinopathies, effect of drugs or immobilization and benign familiar hypocalciuric hypercalcaemia (caused by inactivation mutation in calcium - sensing receptor gene) are necessary to exclude. At the end of the article the step diagnostic procedure in hypercalcaemia is outlined.

Kalvachova B.,Endokrinologicky Ustav
Pediatrie pro Praxi | Year: 2012

Although thyroid axis disorders are increasingly frequent in the population, hyperthyroidism in childhood is a rare condition. The incidence increases with age, with more than 60% of immunogenetic forms of hyperthyroidism occurring between 10 and 15 years of age, more frequently in girls. A positive family history of autoimmune thyroiditis, clinical symptoms and laboratory tests make the detection of hyperthyroidism in the first line relatively simple. Differential diagnosis, treatment and surveillance of these patients fall within the competence of a paediatric endocrinologist.

Starka L.,Endokrinologicky Ustav
Interni Medicina pro Praxi | Year: 2012

Age related decrease of testosterone levels has been established many times. Late-onset hypogonadism is accompanied by rather unspecific symptoms including vasomotor and nervous signs, disturbances of mood and cognitive function and decease and weakening of sexual functions. Guidelines from expert committees are at disposal for the examination of the hypogonadal patients, diagnosis, treatment and monitoring of the hormonal substitution. Recent guidelines underline that the adepts for testosterone reatment are only those men, in which clinical signs are accompanied by repeated subnormal levels of testosterone. The treatment should be strictly individual. Hypotestosteronemia is also present in a high deal of patient with civilisation diseases as obesity, metabolic syndrome, diabetes mellitus type 2 and cardiovascular diseases. However, until now we don't know whether hypotestosteronemia is one of the causal factors of these diseases or only their consequence.

Starka L.,Endokrinologicky Ustav
Interni Medicina pro Praxi | Year: 2012

In the course of aging the hormonal regulation originating in the axis hypothalamus-pituitary-adrenals is changed. The levels of dehydroepiandrosterone (DHEA) decrease markedly, whereas cortisol secretion has tendency to increase. In such way the ratio cortisol/DHEA increases followed by a shift from anabolism to catabolism, from support of immunity processes to their partial inhibition and to the change of neurosteroid activity in the brain. Damped secretion activity is recorded also in adrenal z. glomerulosa and in the course of aging the sensitivity of aldosterone secretion to various challenges is changed. Deficit of DHEA in some limited cases can be ameliorated by supplementation with DHEA; the consequences of higher aldosterone secretion can be corrected by antimineralo-corticoid drugs as spirolactone, ACE-inhibitors or sartanes. Selectively acting anti-mineralocorticoid is not for disposition until now.

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