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Serum amino acid disturbance in multiple myeloma with hyperammonemia
H Matsuzaki1, H Hata, T Sonoki
1Second Department of Internal Medicine, Kumamoto University School of Medicine, Japan.
Abstract:
From October 1987 to November 1993 we evaluated the serum levels of ammonia and amino acids in 85 patients with multiple myeloma. Six of the 85 cases of multiple myeloma demonstrated hyperammonemia and none of the known causes of hyperammonemia, such as liver failure, could be identified in these patients. All six patients also showed serum amino acid disturbances and conscious disorders in various degrees. In this study we compared these abnormalities in multiple myeloma with those in chronic liver failure (n = 14), the basic diseases of which were liver cirrhosis in six cases and liver cirrhosis complicated hepatocellular carcinoma in eight cases. There was a marked difference in the levels of individual serum amino acids between these two groups. The level of glycine was significantly higher in the multiple myeloma group (P < 0.001); on the other hand, that of tyrosine was significantly higher in the liver failure group (P < 0.005). The histidine (P < 0.005) and arginine (P < 0.005) levels were lower in the myeloma group. The ratio of glycine to tyrosine (Gly/Tyr) was 16.7 +/- 4.85 in the myeloma group and 1.7 +/- 0.12 in the liver failure group. The ratio of glycine to tyrosine was an important criterion for differential diagnosis.
Insights
Multiple myeloma patients can develop hyperammonemia, distinct from liver failure. Specific amino acid level differences, like higher glycine and lower histidine/arginine in myeloma, aid diagnosis.
Area of Science:
- Biochemistry
- Oncology
- Hepatology
Background:
- Investigating metabolic disturbances in multiple myeloma.
- Understanding the causes of hyperammonemia in non-hepatic conditions.
Observation:
- Six of 85 multiple myeloma patients exhibited hyperammonemia without identifiable liver failure.
- These patients also presented with serum amino acid abnormalities and varying degrees of conscious disorders.
Findings:
- Distinct serum amino acid profiles differentiate multiple myeloma from chronic liver failure.
- Multiple myeloma group showed significantly higher glycine (P < 0.001) and lower histidine (P < 0.005) and arginine (P < 0.005) levels.
- Liver failure group had significantly higher tyrosine levels (P < 0.005).
Implications:
- The glycine to tyrosine ratio (Gly/Tyr) serves as a key diagnostic marker.
- This research highlights unique metabolic alterations in multiple myeloma.
- Distinguishing hyperammonemia causes is crucial for appropriate patient management.