A case with hypercalcemia caused by hyperparathyroidism and multiple myeloma
Banu Avcioglu1, Taner Bayraktaroglu1, Ayse Kubat Uzum1, Sevgi Kalayoglu Besisik2, Ferihan Aral1, Nese Colak1, Fatma Harika Boztepe1 & Faruk Alagöl1
Aim: Hypercalcemia is particularly complicated with hyperparathroidism or malignancy such as myeloma. There were several cases report abouth primary hyperparathroidism coexistent with benign monoclonal gammopathy or multiple myeloma. We present clinical managament of a patient who have hypercalcemia caused by hyperparathyroidism and multiple myeloma.
Case: Fifthy-two years old a women, she was complaint with weakness by anemia due to ferrum deficiency. During the evaluation, hypercalcemia and monoclonal gammopathy were detected, and she was admitted to the hospital. Hyperparathyroidism was diagnosed by hypercalcemia (12.6 mg/dl), hypophosphatemia (2.5 mg/dl) and increased parathyroid hormone (149 pg/ml) values. Multiple myeloma was diagnosed by serum gamma-globulin component of 3.47 g/dl with a monoclonal gammopathy spike and peripheral plasmacytosis of 7%. Serum and urine immunoelectrophoresis revealed abnormal IgG and kappa arcs. Multiple myeloma was defined by kappa chain and IgG type plasma cell discrasia in bone marrow biopsy. Glucocorticoid suppression decreased serum calcium levels. Parathyroid sonography and scintigraphy showed an adenoma. She was referred previously to surgery before the management of myeloma.
Conclusion: The association between primary hyperparathyroidism and monoclonal gammopathy was discussed in terms of possible pathogenetic mechanisms by several cases report in the literature. Primary hyperparathyroidism should be suspected in patients with hypercalcemia and multiple myeloma. Most suitable management should be done for each clinical condition.