Search

La hipercalcemia severa es un trastorno hidroelectrolítico con expresión clínica variable que puede ser grave si no se toman las medidas correctoras adecuadas. Entre las principales causas de hipercalcemia se encuentran el hiperparatiroidismo primario y las neoplasias. Sin embargo, parece ser que están aumentando los casos de una tercera causa de hipercalcemia secundaria. El síndrome de calcio y alcalinos, anteriormente denominado como síndrome de leche y alcalinos, es un trastorno derivado de la excesiva ingesta de calcio y compuestos alcalinos que cursa con hipercalcemia, alcalosis metabólica y fallo renal. Uno de los causantes de este síndrome es la ingesta de antiácidos de carbonato cálcico para las dispepsias, que también se utilizan (algunas veces junto con metabolitos de la vitamina D) para tratar patologías óseas o en tratamientos médicos posquirúrgicos tras la intervención de las glándulas tiroideas y paratiroideas. Describimos cuatro casos de pacientes que desarrollaron este síndrome con hipercalcemia grave en el contexto del tratamiento del hipoparatiroidismo posquirúrgico con el objetivo de sensibilizar a clínicos y pacientes acerca de los riesgos potenciales de los suplementos de calcio asociados a calcitriol. [ABSTRACT FROM AUTHOR]

BACKGROUND: Primary hyperparathyroidism is the most common cause of hypercalcemia and is most frequently identified in early postmenopausal women with hypercalcemia and abnormal parathyroid hormone concentrations. CLINICAL CASE: A 62-year-old female patient who presented to the emergency room in a state of septic shock secondary to pyelonephritis due to extensive renal calcifications, antimicrobial and amine treatment was started, parathyroid hormone was requested, which was very high, and left nephrectomy was performed after exclusion by scintigraphy, with improvement but persistence of leukocytosis, procedures were performed for the study and treatment of pleural effusions, and a diagnosis of overlap syndrome was integrated with right ureterolithotripsy and later, parathyroidectomy. CONCLUSIONS: There are no established treatment guidelines for overlap syndrome. High-risk patients suitable for intensive treatment should be considered for allogeneic transplantation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute pancreatitis is the most common gastrointestinal disease in hospital admissions. The predominant causes are: gallstones (40%), prolonged alcohol consumption (30%) and hypertriglyceridemia (2-5%). Other less frequent causes are related to drugs, trauma, ischemia, infections, autoimmune diseases, endoscopic retrograde cholangiopancreatography and hypercalcemia. CLINICAL CASE: A 54-year-old patient with acute pancreatitis associated to goiter, bilateral renal lithiasis, and hypercalcemia, with no important pathological history for the current disease. Therefore, a study protocol was performed as a reason for acute pancreatitis, finding primary hyperparathyroidism due to a parathyroid adenoma as cause of the acute disease. CONCLUSIONS: In this case, definitive surgery avoided acute complications, and could prevent disability and chronic or recurrent pancreatitis readmissions, that could lead the patient even to death. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bone marrow fibrosis is characterized by increased deposition of reticulin fibers and, in some cases, collagen fibers. There is a series of hematological and non-hematological disorders that are associated with an increase in bone marrow fibrosis. Non-small cell lung cancer represents 85% of all cases of lung cancer. Bone metastasis is one of the most common complications among lung cancer survivors. Some patients with bone metastases may suffer pathological fracture, compression of the spinal cord or malignant hypercalcemia. CLINICAL CASE: A 57-year-old male patient with a history of diabetes mellitus and smoking, who presented with a clinical picture of low back pain of 4 months of evolution; at admission he had hypercalcemia, acute kidney injury, anemia and osteolytic lesions. A diagnostic approach of hypercalcemia of neoplastic origin was made. CONCLUSIONS: The approach of a patient with high suspicion of multiple myeloma was carried out, without being able to establish that diagnosis, for which reason an iliac crest biopsy and tomographic study were requested, documenting bone marrow fibrosis associated with metastatic pulmonary adenocarcinoma. [ABSTRACT FROM AUTHOR]

Introduction. Familial hypocalciuric hypercalcemia is a rare inherited calcium metabolism disorder in which an alteration of the parathyroid hormone secretion set-point causes hypercalcemia with relative hypocalciuria. Some data suggest that its prevalence is around 74.1 per 100,000 inhabitants. Often, patients are asymptomatic. However, they can develop mild symptoms and an overactive parathyroid adenoma, its main differential diagnosis. The objective was to describe a patient's case and highlight the importance of clinical suspicion and diagnosis to avoid unnecessary surgical neck explorations for parathyroid adenomas. Case report. This is the case of a 40-year-old man with a biochemical profile compatible with primary hyperparathyroidism with anatomical and functional images negative for adenoma and a calcium/creatinine clearance ratio below 0.001, considering familial hypocalciuric hypercalcemia. Genetic studies evidence a mutation in the calcium sensor receptor gene and confirm the diagnosis. Discussion. Familial hypocalciuric hypercalcemia's main differential diagnosis is an overactive parathyroid adenoma. For both, mild or no symptoms may be present; serum calcium exceeds the upper limit, and parathormone is more than 25pg/ml. The calcium/creatinine clearance ratio should be used to differentiate one from the other and avoid unnecessary surgical neck explorations. Besides the lack of information on this topic, evidence supports the use of calcimimetics to treat symptomatic hypercalcemia. Conclusions. Patients with mild hypercalcemia with parathyroid hormone readings above 25pg/ml and a calcium/creatinine clearance ratio below 0.001, or patients with primary hyperparathyroidism with negative imaging, should not undergo surgical neck explorations. In these cases, familial hypocalciuric hypercalcemia is a reliable diagnosis; Cinacalcet may be administered in cases of symptomatic hypercalcemia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute hypercalcemia is a life-threatening condition that most commonly results from malignancy. Local osteolytic hypercalcemia (the local destruction of bone by tumor with calcium release) accounts for about 20% of cancer-related hypercalcemia. Destruction of bone by metastatic cancer is a late event, starting when tumor cells proliferate. Symptoms and complications of bone metastases (pain, pathologic fractures, compression of the spinal cord) become more evident as the disease becomes more extensive. CLINICAL CASE: A 27-year-old female patient that developed acute osteolysis following hypercalcemia of malignancy. CONCLUSIONS: What makes the present case unique was the rapid evolution of osteolysis during the hypercalcemic crisis, evidenced by computed tomography, in a temporality of only 14 days. [ABSTRACT FROM AUTHOR]

BACKGROUND: Primary hyperparathyroidism is diagnosed by hypercalcemia and elevated parathyroid hormone levels. The cause of this is mainly by a parathyroid adenoma in 80% of cases. The differential diagnosis includes familial hypocalciuric hypercalcemia and secondary and tertiary hyperparathyroidism. Many cases are asymptomatic while others have bone, kidney, cardiovascular, neuropsychiatric and gastrointestinal disease. CLINICAL CASE: A 55-year-old female patient who began her condition approximately 20 years ago with the presence of recurrent urinary tract infections. She was diagnosed with bilateral renoureteral lithiasis that merited extracorporeal ureterolithotripsy with placement of a bilateral JJ catheter in 2018, with no other associated symptoms, hypercalcemia due to primary hyperparathyroidism was suspected. CONCLUSIONS: The diagnosis of primary hyperparathyroidism is established with blood and urinary biochemical tests. Imaging studies help mainly to assess bone and kidney complications and surgical planning. Preoperative biopsy is not recommended. The only curative treatment is parathyroidectomy. Surgical advances provide minimally invasive approaches. Medical treatment is not curative, but it is an alternative to surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Newborn subcutaneous fat necrosis is a rare, benign, self-limited, non-infectious panniculitis that appears in the first weeks of life and is associated to perinatal hypoxia secondary to fetal o maternal factors. It is characterized by erythematous subcutaneous nodules localized on the back of term or post-term newborns. CLINICAL CASES: Two newborns with history of perinatal distress, both oxytocin conducted births with unknown APGAR. In case 1, the birth was complicated with uterine rupture and in case 2, there was maternal history of diabetes mellitus. Both cases presented at 3 weeks of life, mainly on the back, indurated erythematous violaceous nodules. Laboratory exams reported, in case 1, both persistent hypercalcemia and hypertriglyceridemia, and in case 2 transitory hypertriglyceridemia with favorable outcome in both cases. CONCLUSIONS: Subcutaneous fat necrosis of the newborn is generally benign and self-limited. Hypercalcemia is a frequent complication with variable evolution, from asymptomatic to fatal, thus needing a strict control and adequate treatment. The purpose of this written is to make the pediatrician and first contact doctor conscious that, even though the subcutaneous fat necrosis may appear severe, usually is self-limited with an excellent prognosis. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (HPTP) is the third most common neuroendocrine disorder, its main cause is parathyroid adenoma. Within the classification, those adenomas that weigh more than 3.5 g are classified as giant parathyroid adenomas (APG), and are associated with a worse evolution and malignancy. The purpose of this article is to present our diagnostic and therapeutic approach of a patient with HPTP associated with a mediastinal APG. A search in the international literature of the last 10 years revealed that only 8 other centers have reported the extraction of an APG of similar dimensions to ours and in a similar location. Case presentation: A 66-year-old woman with a history of multinodular goiter, thyroid profile and parathormone (PTH) measurement were requested, with a report of 350.60 pg/mL. A thyroid/parathyroid scintigraphy was performed with 99mTc sestaMIBI which reported persistence of a focal area of the concentration located in the topography of the lower pole of the right thyroid lobe. This study was complemented with SPECT-CT, which reported an image of hyperfunctioning right inferior parathyroid compatible with adenoma and the patient was diagnosed with PTH. Finally, resection was performed, obtaining a tumor measuring 7.0 × 4.5 × 2.0 cm, with a weight of 24.5 g. Conclusions: Our case highlights the use of imaging studies to facilitate localization and achieve diagnosis together with clinical presentation and biochemical profile. Selective treatment was achieved safely through a minimally invasive transcervical technique, combined with the measurement of PTH. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHP) is defined as an endocrine disorder characterized by hypercalcemia and elevated or inadequately normal parathyroid hormone (PTH) levels resulting from the excessive secretion of PTH from one or more parathyroid glands. The cause of this disorder is due, in 85%, to a single parathyroid adenoma and most cases (95%) are sporadic, without an identifiable etiologic factor. PHP is asymptomatic in most patients, however, classic symptoms or signs include those derived from renal involvement, where nephrolithiasis is the most frequent clinical manifestation, and those derived from bone affectation and hypercalcemia. The diagnosis is biochemical, without the need for an imaging study, which is performed only as pre-surgical locator tests. The definitive treatment is surgical, being the parathyroidectomy with cervical approach the procedure of choice. [ABSTRACT FROM AUTHOR]

Background: Plasmablastic lymphoma is a high grade non-Hodgkin lymphoma. It is described in patients with HIV infection, post-transplant and advanced age. It appears in the fourth decade of life and the oral cavity is the most common site of affection. Its neoplastic cells express markers of plasma cells such as CD138, CD38. In its pathogenesis the Epstein-Barr virus has been implicated. The most challenging consideration in the differential diagnosis is with multiple myeloma, since the morphological and immunophenotypic characteristics of these two entities are very similar. Treatment with EPOCH (etoposide, epirubicin, vincristine, cyclophosphamide and prednisone) associated with antiretroviral treatment is the most effective option, improving survival to 17 months. Case report: Male of 35 years with HIV and symptoms of organic dysfunction associated with myeloma. Protein electrophoresis and bone marrow aspiration were performed, ruling out multiple myeloma. Continuing with the diagnostic approach and with suspicion of bone neoplasia, a bone biopsy was performed with report of plasmablastic lymphoma CD 138+ and Ki-67 80%, Epstein-Barr positive. He received chemotherapy with EPOCH, with a six-month survival. Conclusions: The presence of organic dysfunction related to myeloma motivated the search for said pathology and the presence of plasmablastic lymphoma was determined; clinical, biochemical, immunohistochemical, and radiographic correlation are essential for correct diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: There are few reported cases of acute pancreatitis secondary to primary hyperparathyroidism in children. Clinical case: Nine-year-old male patient with significant obesity. His current condition of four days of evolution, with abdominal pain in the epigastrium that progressively increased in intensity. Upon admission, the patient was seriously ill. Pancreatitis was confirmed by laboratory results (lipase 1.805 U/L, amylase 784 U/L) and abdominal tomography (cyst and necrosis of the pancreas). Serum calcium was persistently elevated. Primary hyperparathyroidism was diagnosed by elevated levels of parathyroid hormone (314.4 pg/dL) and parathyroid adenoma identified in ultrasound. Conclusions: Primary hyperparathyroidism should be one of the possible causes of pancreatitis in children, particularly when hypercalcemia is detected. [ABSTRACT FROM AUTHOR]

Introduction: Parathyroid cancer is rare. Usually presented as primary hyperparathyroidism, sometimes as hypercalcemic crisis, with general malaise, nausea, vomiting, mood disturbances and low weight. In some cases it occurs as osteitis fibrosa cystica, diffuse osteopenia, osteoporosis and pathological fractures. The diagnosis is usually made by surgical biopsy shows invasion of adjacent structures, or local and distant metastases. The treatment is surgical resection of the tumor, without the use of adjuvant therapies. Their recurrence rate is high, 25 to 100%. Poor prognostic factors are lymph node metastases at initial presentation, distant metastases and nonfunctional carcinomas. Case report: Male patient consulted for 64 years in general conditions, bradypsychia, polyuria, headache and neck mass. He also had hypercalcemia and high elevation of PTH. Surgical resection of the cervical mass was performed, with rapid biopsy atypia and mitosis 1/10, and hyperplastic thyroid nodule. After this, PTH decreased levels as well as levels of calcium. Discussion: Patients with parathyroid cancer tend to have higher serum calcium and PTH of values. For diagnosis, it is not recommended to use needle biopsy, risk of spread and the poor performance of this technique. Conclusion: Despite being rare, you should think parathyroid cancer in the context of a patient with hypercalcemia, especially if you have very high PTH. The clinical suspicion of this diagnosis is directly related to the possibility of treatment and prognosis of the disease. [ABSTRACT FROM AUTHOR]

Resumen Introducción La sarcoidosis es una enfermedad sistémica de etiología desconocida que raramente se presenta en la infancia. Generalmente afecta los pulmones; sin embargo, puede involucrar diversos órganos. Ocasionalmente afecta el estado general, y origina fiebre, hepatomegalia y esplenomegalia. Caso clínico Se presenta el caso de un adolescente de doce años de edad con sarcoidosis infantil de inicio tardío, cuyo diagnóstico fue confirmado con un estudio histopatológico de ganglio linfático. El paciente cursó con afección general, hipercalcemia, eritema nodoso, alteraciones pulmonares graves, adenopatías, hepatomegalia y masa testicular. Recibió tratamiento con esteroides, con excelente respuesta clínica. Conclusiones Se resalta la importancia de considerar el diagnóstico de sarcoidosis en los pacientes con hepatomegalia, adenopatías, daño pulmonar difuso, eritema nodoso, masa testicular e hipercalcemia, así como la necesidad del abordaje multidisciplinario para valorar el compromiso orgánico múltiple y el inicio oportuno de la terapia con esteroides, con el fin de evitar la progresión de la enfermedad. Background Sarcoidosis is a systemic disease of unknown etiology that rarely occurs in children. It usually affects the lungs, however, it may involve various organs. It occasionally affects the general condition, and causes fever, hepatomegaly and splenomegaly. Case report We report the case of a twelve-year-old adolescent with late-onset childhood sarcoidosis which diagnosis was confirmed by lymph node histopathological study. The patient presented general condition, hypercalcemia, erythema nodosum, severe lung disorders, lymphadenopathy, hepatomegaly and testicular mass. He received treatment with steroids, with excellent clinical response. Conclusions We highlight the importance of considering the diagnosis of sarcoidosis in patients with hepatomegaly, lymphadenopathy, diffuse lung damage, erythema nodosum, testicular mass and hypercalcemia, as well as the need for a multidisciplinary approach to assess multiple organ involvement and the early beginning of steroid treatment in order to prevent the progression of the disease. [ABSTRACT FROM AUTHOR]

Hypercalcemia is a rare metabolic disorder in children and is potentially fatal. It has a wide differential diagnosis, including cancer. Here, we report the case of a previously healthy 3-year-old who was admitted to the emergency room with fatigue, hyporeactivity, fever and limping gait that had evolved over 5 days and that was progressively worsening. On examination the patient was unconscious (Glasgow coma score: 8). Laboratory tests indicated severe hypercalcemia (total calcium 21.39mg/dL, ionized calcium 2.93mmol/L) and microcytic anemia. Hyperhydration was initiated, and the child was transferred to the pediatric intensive care unit. Continuous venovenous hemodiafiltration with calcium-free solution was instituted, which brought progressive normalization of serum calcium and an improved state of consciousness. Zoledronate was administered, and metabolic and infectious causes and poisoning were excluded. The bone marrow smear revealed a diagnosis of acute lymphoblastic leukemia. Hypercalcemia associated with malignancy in children is rare and occurs as a form of cancer presentation or recurrence. Continuous venovenous hemodiafiltration should be considered in situations where there is imminent risk to life. [ABSTRACT FROM AUTHOR]

Introduction: Parathyroid Carcinoma is a rare endocrine neoplasia of slow growth but of high aggressiveness whose main treatment is the block resection of the carcinoma. Case report: a patient of the female gender, 73 years old, with severe bone pain, presented PTH = 525,7pg/ml and ionic calcium = 2,15mmol/L, with suspected primary hyperparathyroidism. After neck ultrasonography and scintilography of the parathyroid glands, a neck surgical exploration was performed , followed by an en bloc resection of the carcinoma, with histopathological confirmation of the diagnosis for parathyroid carcinoma. [ABSTRACT FROM AUTHOR]

Background: Brown tumors of bones are an uncommon manifestation of hyperparathyroidism. Case report: We report a 35 years old male presenting with pain and paresis of the left superior limb. Part of his humerus was excised due to a diagnosis of a giant cell tumor. He was admitted again to the hospital due to pelvic pain, malaise and constipation. A right cervical nodule was found. Laboratory evaluation confirmed the presence of a hyperparathyroidism. The biopsy of the pelvic lesion disclosed a brown tumor. The patient was subjected to a parathyroidectomy and the pathological study of the surgical piece showed a right parathyroid adenoma and a right thyroid papillary micro carcinoma. In the postoperative period the patient had a hungry bone syndrome, which was adequately treated. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHPT) is characterized by the autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia or normal-high serum calcium levels in the presence of elevated or inappropriately normal serum PTH concentrations. Exceptionally in symptomatic patients, a diagnosis can be established on the basis of clinical data. PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with osteoporosis-osteopenia, a personal history of neck irradiation, or a family history of multiple endocrine neoplasia syndrome (types 1 or 2). Diagnosis of PHPT is biochemical. Asymptomatic hypercalcemia without guiding signs or symptoms is the most frequent manifestation of the disease. For differential diagnosis, PTH must be measured, as well as phosphate, chloride, 25-hydroxyvitamin D, 1,25 dyhidroxyvitamin D and calcium-to-creatinine clearance. The diagnosis and differential diagnosis of primary hyperparathyroidism will be discussed here. [ABSTRACT FROM AUTHOR]

The endocrine or humoral paraneoplastic síndromes can be defined as clinical entities, caused by a distance effect of a tumor, independiently of the local effect of its metastases, thath ocurrs mediated by the ectopical production of hormonal peptides o their precursors, citokines and rarely by tiroid hormone or D vitamin. The endocrine paraneoplastic syndromes, are important clinic entities associated to many kind of tumors. The importance of the knowledge of this syndromes is the chance to make a early diagnostic of a previously undiagnosed oncologic entity, avoid the diagnostic mistake induced by this syndromes that can be the predominant clinical scenario, or can be useful for monitoring the evolution and response to the treatment of the neoplasm that originate them. In this review are considerated the next paraneoplastic syndromes: the inappropriate secretion of the antidiuretic hormone, the malignancy's hypercalcemia, hypoglycaemia, Cushing syndrome and acromegaly. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism is caused by unique adenoma in 85% of cases; it should be suspected on detecting high blood calcium levels. Prevalence is extremely low in persons under 50 years. High-resolution ultrasound is the imaging mode of choice for diagnostic evaluation. We present the case of a woman 31 years of age in week 20 of pregnancy, with sudden onset primary hyperparathyroidism due to a giant parathyroid adenoma identified during ultrasound exploration of the neck. The patient initially presented neuromuscular values with accelerated deterioration which led to coma. The patient was admitted due to acute pancreatitis associated with hypercalcemic crisis, which was resolved with surgical resection of the tumor. At follow-up she was asymptomatic. Clinical evolution, diagnosis, and treatment are discussed. [ABSTRACT FROM AUTHOR]

The association between vitamin D deficiency and increased risk of, among others, cardiovascular and autoimmune diseases has lead in the last years to an enhanced interest in the usage of supplements to achieve the normalization of plasmatic values at 25(OH) D. Apparently this search for normalization is resulting in an higher incidence on vitamin D intoxication. We present the case of an 81 years old woman with metabolic encephalopathy and renal failure secondary to iatrogenic vitamin D intoxication. Calcium and vitamin D oral supplements were prescribed after an osteoporotic vertebral fracture. The patient improved clinically as well as analytically after receiving treatment with diuretics and hydration. We emphasize the importance of discarding hypercalcemia as a cause of metabolic encephalopathy; moreover we highly recommend keeping vitamin D intoxication in mind as an uncommon although always possible etiology of reversible hypercalcemia and renal failure. [ABSTRACT FROM AUTHOR]

Hypervitaminosis D is a rarely reported condition. In general it is only perceived when hypercalcemia is not resolved. The use of vitamin D has increased in recent years because of its benefits, but as a result, intoxication cases have occurred more frequently. This report describes a patient who presented worsening of renal function and hypercalcemia. After investigation, vitamin D intoxication was confirmed and it was due to an error in compounding. [ABSTRACT FROM AUTHOR]

INTRODUCCIÓN: La leucemia linfocítica aguda es la malignidad hematológica más frecuente en pacientes pediátricos, con una prevalencia estimada del 80%. Las manifestaciones clínicas frecuentes suelen ser fiebre, hepatoesplenomegalia, linfadenopatías, petequias/púrpura, anemia y dolor óseo. Sin embargo, los hallazgos clínicos y las pruebas de laboratorio de nuestro paciente eran más compatibles con un diagnóstico de mieloma múltiple. CASO CLÍNICO: Paciente masculino de 15 años de edad con historia de 4 meses de evolución de dolor lumbar intenso, además de un cuadro clínico de náuseas, vómitos, fiebre no cuantificada, anemia y debilidad generalizada, que al examen físico presenta dolor a la palpación en el área lumbosacra y cresta ilíaca derecha. DISCUSIÓN: El mieloma múltiple suele manifestarse característicamente con afectación ósea, anemia, insuficiencia renal e hipercalcemia, hallazgos infrecuentes para el diagnóstico de leucemia linfocítica aguda y con muy pocos reportes en la literatura (

The mammary neoplasia are the most common tumors in dogs. The hypercalcemia is a complication of some malignancies neoplasia. This study aimed to verify the occurrence of hypercalcemia in dogs suffering from mammary carcinoma. We studied 16 females with breast carcinoma, performing the ionized calcium, whereas, 68.75% had hypercalcemia. [ABSTRACT FROM AUTHOR]

Introducción: Paciente 44años, acude a Urgencias por dolor cervical y vértigo, refiere cefalea y mialgias de 2 semanas de evolución relacionadas con esfuerzo físico. A la exploración física se objetivan cifras de tensión arterial 80/100 mmHg, FC92l pm, ECG y Rx tórax normales. En analítica de urgencias destacan: creatinina 3,03 mg/dL, calcio 17,1 mg/ dL, LDH 308 UI/L. Objetivos: Determinar la etiología de la hipercalcemia del paciente. Material y Métodos: Ante una hipercalcemia (>10,5 mg/ dL), debemos estudiar su etiopatogenia y repercusión orgánica mediante diagnóstico diferencial, sabiendo que las causas más frecuentes (90%) de la hipercalcemia son Hiperparatiroidismo y neoplasias. En la hipercalcemia aparece el Síndrome Hipercalcémico Agudo (SHA): deshidratación, insuficiencia renal, síntomas neuromusculares y cerebrales, alteraciones digestivas y cardiovasculares. Debemos ampliar las pruebas de laboratorio para estudiar probable origen: PTH, TSH, ECA, entre otros. Además, realizar estudio con pruebas de imagen o pruebas técnicas especializadas. Resultados: Respecto a la segunda analítica, determinamos parámetros relacionados con la etiogenia de hipercalcemia: ácido úrico 9,6mg/dL (VR: 2,6-6 mg/dL), PTH 7,4 ng/L(VR: 12-72 ng/ mL), calcitriol: 28 pg/mL(VR: 25-66 pg/mL), TSH 1,46 mcU/ mL (VR: 0,35-5,5 mcU/mL), ECA 33 UI/L. Se realizaron otras pruebas, como Proteinograma y Cadenas libres en suero y orina que fueron normales, Radiografía de serie ósea:, donde se describen imágenes líticas milimétricas difusas en todos los elementos óseos, TAC body, visualizando múltiples imágenes osteolíticas de pequeño tamaño de probable origen tumoral. Tras este hallazgo se realiza Medulograma con biopsia ósea: >55%blastos linfoides B: LLA-B. Conclusiones: Estamos ante un SHA con fracaso renal agudo (FRA) y elevación de la TA no conocida de causa renal (Emergencia Hipertensiva-EH). FRA debido al SHA y la EH. El SHA se relaciona con la hemopatía aguda- LLA-B, atribuido a metástasis osteolíticas y, secundario a la producción local por las células tumorales. Evolución del paciente: normalización del calcio tras hidratación severa, glucocorticoides y calcitonina; función renal mejora y tras el diagnóstico de LLA-B se inicia quimioterapia. [ABSTRACT FROM AUTHOR]