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      Severe Hypercalcemia: A Rare and Unusual Presentation of Childhood Acute Lymphoblastic Leukemia


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          Hypercalcemia in children is a medical emergency and often manifests as nonspecific symptoms such as nausea, vomiting, weight loss, and anorexia. Severe hypercalcemia is a rare complication of malignancy in children, while it can be seen in various types of malignant tumors. It is usually associated with significant morbidity and may be severe enough to threaten life. Incidence of hypercalcemia in hematopoietic malignancies including acute lymphoblastic leukemia (ALL) is very rare and unusual, especially as the initial manifestation of the disease. In this paper a 6-year-old boy who had severe hypercalcemia and gastrointestinal symptoms before the onset of common and usual manifestations of ALL is introduced.

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          Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin's disease and non-Hodgkin's lymphomas.

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            Management of acute hypercalcemia.

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              Hypercalcemia complicating childhood malignancies.

              Hypercalcemia complicating malignancy is a frequent complication in adults, but little has been published about the pathogenesis or the true incidence of hypercalcemia in children with cancer. Hypercalcemia developing in childhood malignancies was studied retrospectively at St. Jude Children's Research Hospital to determine its incidence, the timing of its presentation, and its response to therapy. Over a 29-year period, 25 children (median age, 9.5 years) had been diagnosed and treated for hypercalcemia that occurred during the course of their malignancy. These 25 represented 0.4% of the total number of children treated for cancer at the institution during that period. Their malignancies comprised acute leukemias (11; 0.6%), rhabdomyosarcoma (4; 1.2%), malignant rhabdoid tumor (2), Hodgkin disease (1), non-Hodgkin lymphoma (1), hepatoblastoma (2), neuroblastoma (1), brain tumor (1), angiosarcoma (1), and a solid malignant tumor of undetermined type. Patients with acute lymphoblastic leukemia were more likely to present with hypercalcemia at the time of their initial diagnosis and to achieve resolution of this complication, whereas patients with solid tumors presented with hypercalcemia later in the course of their disease and had hypercalcemia that was more resistant to therapy. In contrast to adults with cancer, hypercalcemia of malignancy is extremely rare in children.

                Author and article information

                Int J Hematol Oncol Stem Cell Res
                Int J Hematol Oncol Stem Cell Res
                International Journal of Hematology-Oncology and Stem Cell Research
                Tehran University of Medical Sciences
                : 8
                : 2
                : 38-40
                [1 ]Assistant professor of pediatric hematology-oncology, Oncopathology research center, Ali Asghar children's hospital, Iran University of medical sciences, Tehran, Iran
                [2 ]Assistant professor of pediatric hematology-oncology, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
                Author notes
                Corresponding Author: Ghasem Miri-Aliabad, Department of Pediatrics, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. P.O.Box: +9816743111, Tel: +985413411250, Fax: +985413411251. E-mail: gh_miri@ 123456yahoo.com
                © 2014 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                Case Report

                acute lymphoblastic leukemia,hypercalcemia,children
                acute lymphoblastic leukemia, hypercalcemia, children


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