HYPERCALCEMIA

From Big Medical Encyclopedia

HYPERCALCEMIA (grech, hyper-+ calcium + grech, haima blood) — strengthening of the general calcium in a blood plasma of St. 11 mg of % (5,7 mekv/l) that usually is followed by development of clinical displays of giperkaltsiyemichesky intoxication.

Distinguish the idiopathic G. and secondary forms G. which are found at some diseases.

Secondary forms of a hypercalcemia are observed at conditions of a hyper parathyroidism, at a caries (leukemic infiltration, metastasises of tumors). It is observed also at hyper - and especially a hypothyroidism, at a sarcoidosis and other tumoral processes, at plazmotsellyulyarny pneumonia at children, an aseptic necrosis of hypodermic cellulose, and also at a hypophosphatasia. The hypervitaminosis of D is the most important reason of giperkaltsiyemichesky intoxication at children.

The idiopathic hypercalcemia was for the first time described in 1952 in England by Schlesinger (V. Schlesinger) and in Switzerland G. Fankoni.

The pathogeny

the Pathogeny of a disease is not studied, assume that idiopathic G. includes several diseases of exchange differing on origins, but leading to permanent increase in level of calcium in plasma. F. Kenny's observations with sotr testify to a role of hereditary factors in idiopathic G.'s origin. (1963) diseases at twins and Huft (S. Hooft) with sotr. (1961) — at children whose parents suffered from a sarcoidosis. To one of the factors leading to idiopathic G.'s development serve hereditarily the caused hypersensitivity to vitamin D. It is known that the disease can arise at introduction fiziol, doses of vitamin and it is even spontaneous. Except primary hereditary factors, sensitivity to vitamin D is increased by conditions of a hypothyroidism, an immobilization of the child with to lay down. purposes. To one of possible signs of such hypersensitivity of an organism to vitamin D can serve early closing of a big fontanel and tendency to development of a craniostenosis. At idiopathic G.'s patients find a superactivity of vitamin D in a blood plasma [Smith with sotr., 1959]. Also hereditary disease at twins is described, characteristic signs to-rogo were a hypercalcemia with a nephrocalcinosis and an indicanuria [Drummond (To. N. Drummond) with sotr., 1964].

The clinical picture

Clinically idiopathic G. is shown at early age by anorexia, a delay physical. development, signs of damage of kidneys (polydipsia, polyuria, isosthenuria, leukocyturia, and also moderate proteinuria and cylindruria). The hypomyotonia is noted, displays of dehydration are frequent, the general cyanosis, the ABP it is raised, systolic noise is quite often listened. Vomiting and locks are observed. Removal of calcium with urine is considerably increased, in blood find a hypercalcemia, a hyperazotemia, decrease of the activity of an alkaline phosphatase. Content of inorganic phosphates in blood depends on a phase of a disease and extent of disturbance of a functional condition of kidneys. At rentgenol, a research of tubular bones intensive zones of calcification of epiphyseal lines are found. The long current of G. leads to development of a nephrocalcinosis, adjournment of salts of calcium in a mucous membrane of a stomach, in lungs and an aorta.

Idiopathic G. should be differentiated with renal tubular acidosis.

Treatment

Treatment consists in restriction of intake of calcium with food (an exception of cow's milk of a diet of the baby, use of the milk processed by cation-exchange resins, sodium sulfate). In some cases to lay down. the effect is rendered by corticosteroids, vitamin A, being antagonists of vitamin D concerning influence on exchange of calcium. It is known that adjournment of salts of calcium in soft tissues at a hypercalcemia is interfered by pyrophosphates or their synthetic analogs — phosphonates which can be perspective at treatment of. At the same time attempts to apply with to lay down. the purposes complexons like EDTA, and also salts phytin to - you were not crowned with success yet.

Forecast

Forecast generally adverse. Children perish from nephrocalcinosis (see) and renal failure (see). Also tranzitorny form meets a favorable current.


Bibliography: Ignatova M. S. ivel-tishchev Yu. E. Diseases of kidneys at children, M., 1973; F and n with about n i G. u. a. Chronische Hypercalcamie kombiniert mit Osteoskle-rose, Hyperazotamie, Minderwuchs und kon-genitalen Missbildungen, Helv. paediat. Acta, Bd 7, S. 314, 1952; K e n n y F. M. a. o. Metabolic studies in a patient with idiopathic hypercalcemia of infancy, J. Pe-diat., v. 62, p. 531, 1963.

BB. E. Veltishchev.

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