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Skeleton and Calcium Homeostasis01:21

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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Calcitonin, a vital polypeptide hormone, regulates calcium levels within body fluids. It is released by the parafollicular cells, also known as C cells, situated in the follicular epithelium of the thyroid gland. Calcitonin responds to fluctuations in blood calcium levels and the influence of gastrointestinal hormones like gastrin and cholecystokinin.
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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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In humans, electrolytes play a vital role in various physiological processes. Balancing electrolyte levels is essential for normal body functions; their imbalance can be life-threatening. The major electrolytes include sodium, potassium, chloride, calcium, phosphate, and bicarbonate. They are primarily involved in physiological processes, such as nerve signal transmission, membrane trafficking, muscle contraction, buffering body fluids, and balancing water levels in the body.
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Calcium is an essential signaling molecule required for various cellular functions. Calcium pumps and ion channels on cell and organellar membranes, such as those on the endoplasmic reticulum (ER), regulate calcium concentrations inside the cell. They remain closed, keeping the cytosolic calcium levels low at a resting state.
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A Curious Case of Hypercalcemia.

Thi My Linh Tran1, Houda Abdelrahman2, Chau Tran3

  • 1Warren Alpert Medical School of Brown University, Providence, RI; Department of Internal Medicine, Kent Hospital, Warwick, RI.

Rhode Island Medical Journal (2013)
|March 29, 2022
PubMed
Summary
This summary is machine-generated.

Humoral hypercalcemia of malignancy, a rare complication, was observed in an 81-year-old female with urothelial cancer. This case highlights a rare presentation of urothelial carcinoma with squamous cell differentiation.

Keywords:
hypercalcemia of malignancyoncologyurothelial cancer

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Area of Science:

  • Oncology
  • Urology
  • Endocrinology

Background:

  • Humoral hypercalcemia of malignancy (HHM) is a paraneoplastic syndrome characterized by elevated serum calcium levels.
  • HHM is most commonly associated with squamous cell lung cancer, breast cancer, renal cancer, and ovarian cancer.
  • Its occurrence in urothelial cancer is exceedingly rare.

Observation:

  • An 81-year-old female presented with severe altered mental status due to markedly elevated serum calcium.
  • Diagnostic workup revealed urothelial carcinoma as the underlying cause of hypercalcemia.
  • The patient's urothelial carcinoma exhibited squamous cell differentiation.

Findings:

  • This case represents a rare instance of humoral hypercalcemia of malignancy in a patient with urothelial cancer.
  • The patient's presentation underscores the potential for severe metabolic disturbances in advanced urothelial malignancies.
  • This report adds to the limited literature on urothelial carcinoma with squamous cell differentiation, with only three prior cases documented.

Implications:

  • Recognizing HHM in urothelial cancer is crucial for timely diagnosis and management of both the hypercalcemia and the underlying malignancy.
  • This case emphasizes the importance of considering paraneoplastic syndromes in patients with unexplained hypercalcemia, even in rare cancer types.
  • Further research into the mechanisms and management of HHM in urothelial cancer may improve patient outcomes.