Analysis Of Clinical Features Of Hypercalcemia Caused By Malignant Tumors And Primary Hyperparathyroidism

Objective: To compare the clinical features,diagnosis and treatment of hypercalcemia caused by malignant tumors and primary hyperparathyroidism(PHPT),so as to strengthen the understanding of the disease and improve the level of clinical diagnosis and treatment.Methods: Collecting the clinical data of 75 patients who were hospitalized in the first hospital of Lanzhou University from November 2007 to August 2018 and diagnosed as hypercalcemia.According to the etiology,the patients were divided into two groups: malignant tumor group and PHPT group.To compare the general conditions,clinical manifestations,laboratory tests,imaging examinations,treatments,and therapeutic effects of patients with hypercalcemia caused by two different causes.Results: 1.Among the 75 patients with hypercalcemia,31 were in the malignant tumor group and 44 in the PHPT group.There were 35 males(46.7%)and 40 females(53.3%)with an average age of 55.76±13.92 years.2.The length of hospital stay in the PHPT group [14(9-21)days] was longer than that in the malignant tumor group [11(5-14)days](P < 0.05).There was no significant difference in age or course of disease between the two groups(P > 0.05).3.In the malignant tumor group,there were 13 cases of multiple myeloma(17.3%),6 cases of lung cancer with bone metastasis(8.0%),2 cases of bone metastasis(unknown primary lesion),2 cases of laryngeal cancer with bone metastasis(2.7%),2 cases of breast cancer with bone metastasis(2.7%),and each one case of cervical cancer with bone metastasis,liver cancer,renal cancer,gastric cancer,gallbladder cancer and oral cancer.In the PHPT group,34(45.3%)patients with parathyroid gland showed abnormal radionuclide distribution concentrated foci by 99 m Tc-MIBI scan;26 patients(34.7%)underwent surgical treatment,including 19 cases(25.3%)of parathyroid adenoma,6 cases(8.0%)of parathyroid carcinoma,1 case(1.3%)of hyperparathyroidism.4.After correcting serum calcium menstrual protein,serum calcium levels(3.33± 0.60 mmol /L)in PHPT group were lower than that of levels before correction(3.36± 0.61 mmol /L),and serum calcium levels(3.63±0.51 mmol /L)in malignant tumor group were higher than that of before correction(3.53 ±0.49mmol/L,all P < 0.01).5.In patients with mild hypercalcemia,PHPT was significantly more than that of malignant tumors(P < 0.01),while there was no significant difference between the two causes of moderate and severe hypercalcemia(P > 0.05),and there was no significant difference in the incidence of hypercalcemia crisis between the two causes(P > 0.05).6.The levels of serum calcium,corrected serum calcium,serum phosphorus,serum urea nitrogen,serum creatinine,serum uric acid and lactate dehydrogenase in the malignant tumor group were higher than those in the PHPT group(all P < 0.05),while the levels of serum albumin,alkaline phosphatase and PTH were significantly lower than those in the PHPT group(all P < 0.01).There was no significant difference in creatine kinase levels between the two groups(P > 0.05).7.Among 54 cases(72.0%)with multiple systemic manifestations,29 patients(38.7%)had two systemic clinical manifestations,18 patients(24.0%)had three systemic clinical manifestations,and 7 patients(9.3%)showed four systematic clinical manifestations.The incidence of urinary symptoms in the PHPT group was significantly higher than that in the malignant tumor group(P<0.01).8.The percentage of patients with malignant tumors treated with 2-3 calcium reductions(28.0%)was significantly higher than that of the PHPT group(21.3%,P < 0.05).9.The total effective rate of treatment in the PHPT group(46.7%)was higher than that in the malignant tumor group(26.7%,P<0.05).The decrease of serum calcium in patients with PHPT group was significantly higher than that in malignant tumor group(P<0.05),and the increase of serum phosphorus was significantly higher than that in malignant tumor group(P<0.05).Conclusion: 1.The causes of mild hypercalcemia were mostly found in PHPT,and there was no difference between moderate and severe hypercalcemia.2.Hypercalcemia was usually manifested as multi-system symptoms.PHPT patients were more likely to have urinary system symptoms and stay in hospital longer.The corrected serum calcium and phosphorus levels of MAH patients were higher than that of PHPT,and the levels of PTH and alkaline phosphatase were lower than that of PHPT.3.The therapeutic effect of hypocalcemia in MAH patients was poor,so a variety of hypocalcemia treatment measures should be taken,however,the effect of PHPT was good.