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array:12 [ "idiomaDefecto" => true "titulo" => "IgG4-related disease: description of a case with pulmonary lesions, mediastinal lymphadenopathies and rapidly progressive renal failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "218" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad relacionada con IgG4: descripción de un caso con lesiones pulmonares, adenopatías mediastínicas e insuficiencia renal rápidamente progresiva" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => 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] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251415124317?idApp=UINPBA000064" "url" => "/20132514/0000003500000002/v0_201504231604/X2013251415124317/v0_201504231606/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Acute kidney injury secondary to very severe hypercalcaemic crisis caused by primary hyperparathyroidism" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "226" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Andrea Chacón, Ana Vilar, David Arroyo, Felipe Sarró, Lourdes Craver, Susana Ros, Carolina López, Alex Castillo, Xavier Matías-Guiu, Elvira Fernández-Giráldez" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Andrea" "apellidos" => "Chacón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Ana" 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array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 7 => array:3 [ "nombre" => "Alex" "apellidos" => "Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] 8 => array:3 [ "nombre" => "Xavier" "apellidos" => "Matías-Guiu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] 9 => array:3 [ "nombre" => "Elvira" "apellidos" => "Fernández-Giráldez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Nephrology, Hospital Arnau de Vilanova [Arnau de Vilanova Hospital], Lleida, Lleida (Spain) " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Digestive System and General Surgery, Hospital Arnau de Vilanova, Lleida, Lleida (Spain) " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Endocrinology, Hospital Arnau de Vilanova, Lleida, Lleida (Spain) " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Pathology, Hospital Arnau de Vilanova, Lleida, Lleida (Spain)" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracaso renal agudo secundario a crisis de hipercalcemia muy severa por hiperparatiroidismo primario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412449fig2.jpg" "Alto" => 1066 "Ancho" => 737 "Tamanyo" => 167391 ] ] "descripcion" => array:1 [ "en" => " Parathyroid scintigraphy with Tc 99m-sestamibi; B) Surgical piece; C) Histology of parathyroid adenoma" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic">Dear Editor, </span></p><p class="elsevierStylePara"> Hypercalcaemic crisis is a rare form of presentation of primary hyperparathyroidism. Only small case series have been reported in the literature (1,2). It is characterised by severe hypercalcaemia, renal failure and an altered state of consciousness. We present the case of a 70-year-old patient, who was admitted for acute kidney injury caused by a hypercalcaemic crisis within the context of previously undetected primary hyperparathyroidism. The therapeutic approach and patient progress are discussed.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Clinical Case </span></p><p class="elsevierStylePara"> The patient is a 70-year-old white male with a history of benign prostatic hyperplasia, recurrent atrial fibrillation and right hemithyroidectomy due to nodular hyperplasia, as well as chronic kidney disease that had not been studied (baseline creatinine 1.5 mg/dL).</p><p class="elsevierStylePara"> He was admitted to the emergency room due to symptoms that included unsteady gait and generalized weakness, which had been progressing in the last three months and for which the patient had been previously treated at another hospital. Upon physical examination, the patient was dehydrated, confused, bradypsychic, and presented distal tremor.</p><p class="elsevierStylePara"> Table 1 summarizes the laboratory data, which highlight a significant deterioration in renal function, severe hypercalcaemia and marked increase in PTH levels (20 times the laboratory reference value). Treatment was initiated with IV fluid therapy, infusion of furosemide, and intravenous corticosteroids, bisphosphonates and calcitonin. Due to the severity of the neurological symptoms, urgent simultaneous renal replacement therapy was indicated by means of haemodialysis with low calcium dialysate. The patient showed temporary clinical improvement, but, due to the persistent renal failure and rebound hypercalcaemia (increase in blood calcium level > 2 mg/dL 24 hours post-haemodialysis), continued daily session were required.</p><p class="elsevierStylePara"><img alt="Table I Baseline and progressive laboratory data" src="498v35n02-90412449fig1.jpg"></img></p><p class="elsevierStylePara"> The etiologic study ruled out myeloproliferative processes and other neoplasms (no monoclonal component in the protein analysis; negative Bence-Jones proteinuria), infectious disease (nonreactive serology) and autoimmune diseases. Renal ultrasound demonstrated normal-sized kidneys and good cortico-medullary differentiation. The thoracic-abdominal CT scan showed a retroesophageal mass measuring 5.6 × 3.2 × 6.8 cm, which was suspicious for parathyroid tumour, in addition to bilateral hypodense adrenal nodules: right 27 × 18 mm and left 15 × 11 mm. Parathyroid scintigraphy confirmed the image (Figure 1A).</p><p class="elsevierStylePara"><img alt="Figure 1 Parathyroid scintigraphy with Tc 99m-sestamibi; B) Surgical piece; C) Histology of parathyroid adenoma " src="498v35n02-90412449fig2.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 – Parathyroid scintigraphy with Tc 99m-sestamibi; B) Surgical piece; C) Histology of parathyroid adenoma </span></p><p class="elsevierStylePara"> The Endocrinology Unit was consulted about these findings, and phaeochromocytoma was ruled out (negative urine catecholamine and metanephrine). In a joint session with the General Surgery Unit, surgical management was decided upon, which included resection of an 8-cm parathyroid tumour <span class="elsevierStyleBold">(Figure 1B)</span>. The Pathology Unit reported the mass to be a parathyroid adenoma with no capsular or vascular invasion <span class="elsevierStyleBold">(Figure 1C)</span>.</p><p class="elsevierStylePara"> During the immediate post-operative period, the patient developed “hungry bone syndrome” and therefore required intravenous and oral calcium supplementation for severe hypocalcaemia as well as daily haemodialysis sessions until nine days after the surgery.</p><p class="elsevierStylePara"> Nine months later, the patient is asymptomatic, with calcaemia within normal limits and no need for supplements as well as partial recovery of renal function (creatinine 2.7 mg/ dL, <span class="elsevierStyleBold">Figure 2</span>). It should be noted that renal function is still altered one year after the surgery, despite calcaemia normalization.</p><p class="elsevierStylePara"><img alt="Figure 2 Progress of calcaemia and renal function" src="498v35n02-90412449fig3.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 2 – Progress of calcaemia and renal function</span></p><p class="elsevierStylePara"> The great majority of parathyroid adenomas are asymptomatic, and only a small percentage cause severe hypercalcaemia and renal failure requiring renal replacement therapy (3-4). A recent and extensive literature review only identified 17 cases of hypercalcaemia > 20 mg/dL, with a mortality rate of 60% (5). There are only three cases reported with calcaemia > 30 mg/dL (6-8).</p><p class="elsevierStylePara"> The most relevant aspects in this case report are:</p><p class="elsevierStylePara"> • The onset of a parathyroid adenoma as severe hypercalcaemia</p><p class="elsevierStylePara"> • Renal failure secondary to hypercalcaemia crisis that required renal replacement therapy and only partially recovered after correcting the cause of the hypercalcaemia</p><p class="elsevierStylePara"> • The large size of the parathyroid tumour with non-malignant histology</p><hr></hr><p class="elsevierStylePara"><a href="http://dx.doi.org/10.3265/Nefrologia.pre2014.Oct.12780" class="elsevierStyleCrossRefs">http://dx.doi.org/10.3265/Nefrologia.pre2014.Oct.12780</a></p><p class="elsevierStylePara"> * <span class="elsevierStyleItalic">Corresponding author</span>.<br></br> Andrea Chacón, Nephrology, <br></br> Arnau de Vilanova Hospital, Magdalena 33, 25007, <br></br> Lleida, Lleida, Spain. <span class="elsevierStyleItalic">Tel.: </span>622456547 <span class="elsevierStyleItalic"><br></br> E-mail:</span><a href="mailto:mytleya@gmail.com" class="elsevierStyleCrossRefs">mytleya@gmail.com</a></p>" "pdfFichero" => "498v35n02a90412449pdf001.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl1" "etiqueta" => "Table" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "498v35n02-90412449fig1.jpg" "imagenAlto" => 625 "imagenAncho" => 1037 "imagenTamanyo" => 91073 ] ] ] ] ] "descripcion" => array:1 [ "en" => "I Baseline and progressive laboratory data" ] ] 1 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412449fig2.jpg" "Alto" => 1066 "Ancho" => 737 "Tamanyo" => 167391 ] ] "descripcion" => array:1 [ "en" => " Parathyroid scintigraphy with Tc 99m-sestamibi; B) Surgical piece; C) Histology of parathyroid adenoma" ] ] 2 => array:8 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "498v35n02-90412449fig3.jpg" "Alto" => 950 "Ancho" => 900 "Tamanyo" => 88689 ] ] "descripcion" => array:1 [ "en" => " Progress of calcaemia and renal function" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hiperparatiroidismo primario y crisis hipercalcémica aguda tóxica. 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2024 August | 82 | 54 | 136 |
2024 July | 59 | 26 | 85 |
2024 June | 81 | 35 | 116 |
2024 May | 84 | 28 | 112 |
2024 April | 66 | 28 | 94 |
2024 March | 69 | 22 | 91 |
2024 February | 48 | 37 | 85 |
2024 January | 66 | 25 | 91 |
2023 December | 91 | 41 | 132 |
2023 November | 112 | 65 | 177 |
2023 October | 93 | 29 | 122 |
2023 September | 94 | 30 | 124 |
2023 August | 65 | 27 | 92 |
2023 July | 60 | 23 | 83 |
2023 June | 96 | 19 | 115 |
2023 May | 114 | 36 | 150 |
2023 April | 55 | 11 | 66 |
2023 March | 60 | 14 | 74 |
2023 February | 48 | 14 | 62 |
2023 January | 46 | 24 | 70 |
2022 December | 55 | 30 | 85 |
2022 November | 60 | 19 | 79 |
2022 October | 66 | 37 | 103 |
2022 September | 61 | 29 | 90 |
2022 August | 58 | 43 | 101 |
2022 July | 46 | 38 | 84 |
2022 June | 47 | 28 | 75 |
2022 May | 57 | 36 | 93 |
2022 April | 56 | 35 | 91 |
2022 March | 78 | 31 | 109 |
2022 February | 64 | 42 | 106 |
2022 January | 55 | 38 | 93 |
2021 December | 63 | 38 | 101 |
2021 November | 58 | 27 | 85 |
2021 October | 61 | 37 | 98 |
2021 September | 49 | 27 | 76 |
2021 August | 58 | 40 | 98 |
2021 July | 48 | 40 | 88 |
2021 June | 47 | 16 | 63 |
2021 May | 45 | 30 | 75 |
2021 April | 97 | 49 | 146 |
2021 March | 86 | 32 | 118 |
2021 February | 52 | 15 | 67 |
2021 January | 47 | 18 | 65 |
2020 December | 46 | 15 | 61 |
2020 November | 46 | 7 | 53 |
2020 October | 37 | 17 | 54 |
2020 September | 60 | 6 | 66 |
2020 August | 63 | 14 | 77 |
2020 July | 73 | 10 | 83 |
2020 June | 45 | 8 | 53 |
2020 May | 48 | 11 | 59 |
2020 April | 56 | 19 | 75 |
2020 March | 45 | 11 | 56 |
2020 February | 74 | 20 | 94 |
2020 January | 50 | 20 | 70 |
2019 December | 69 | 22 | 91 |
2019 November | 73 | 21 | 94 |
2019 October | 39 | 11 | 50 |
2019 September | 65 | 15 | 80 |
2019 August | 238 | 15 | 253 |
2019 July | 43 | 25 | 68 |
2019 June | 37 | 13 | 50 |
2019 May | 31 | 19 | 50 |
2019 April | 61 | 26 | 87 |
2019 March | 54 | 17 | 71 |
2019 February | 36 | 16 | 52 |
2019 January | 44 | 13 | 57 |
2018 December | 91 | 36 | 127 |
2018 November | 139 | 13 | 152 |
2018 October | 124 | 16 | 140 |
2018 September | 85 | 13 | 98 |
2018 August | 58 | 16 | 74 |
2018 July | 62 | 13 | 75 |
2018 June | 58 | 13 | 71 |
2018 May | 55 | 16 | 71 |
2018 April | 41 | 7 | 48 |
2018 March | 45 | 5 | 50 |
2018 February | 31 | 6 | 37 |
2018 January | 42 | 6 | 48 |
2017 December | 31 | 9 | 40 |
2017 November | 43 | 11 | 54 |
2017 October | 42 | 4 | 46 |
2017 September | 55 | 12 | 67 |
2017 August | 65 | 6 | 71 |
2017 July | 54 | 17 | 71 |
2017 June | 50 | 10 | 60 |
2017 May | 51 | 6 | 57 |
2017 April | 47 | 7 | 54 |
2017 March | 42 | 6 | 48 |
2017 February | 29 | 7 | 36 |
2017 January | 34 | 4 | 38 |
2016 December | 71 | 10 | 81 |
2016 November | 70 | 7 | 77 |
2016 October | 109 | 10 | 119 |
2016 September | 138 | 6 | 144 |
2016 August | 209 | 0 | 209 |
2016 July | 230 | 0 | 230 |
2016 June | 151 | 0 | 151 |
2016 May | 152 | 0 | 152 |
2016 April | 123 | 0 | 123 |
2016 March | 105 | 0 | 105 |
2016 February | 134 | 0 | 134 |
2016 January | 115 | 0 | 115 |
2015 December | 158 | 1 | 159 |
2015 November | 122 | 1 | 123 |
2015 October | 126 | 5 | 131 |
2015 September | 135 | 6 | 141 |
2015 August | 112 | 7 | 119 |
2015 July | 139 | 0 | 139 |
2015 June | 71 | 0 | 71 |
2015 May | 130 | 8 | 138 |
2015 April | 26 | 0 | 26 |