Hypercalcemia of malignancy: a study of clinical features and relationships among circulating levels of calcium, parathyroid hormone and parathyroid hormone-related peptide.

OBJECTIVE: Examine the clinical and biochemical features including serum intact PTH (iPTH) and plasma PTH-related peptide (PTHrP) levels in patients with malignancy-associated hypercalcemia (MAHC). MATERIAL AND METHOD: Forty-eight patients with histopathological or cytological proven malignancies and MAHC who were admitted to Siriraj Hospital were studied. RESULTS: The malignancies that caused MAHC were squamous cell carcinoma (45.8%), non-squamous cell solid tumors (31.3 %), and hematological malignancies (22.9%). Most patients (93.8%) had advanced stage malignancies. Corrected serum total calcium (cTCa) levels were 10.8-19.1 mg/dL (13.6 +/- 2.4) and severe hypercalcemia was observed in 17 cases (40.5%). Serum iPTH levels were 0.95-17.1 pg/mL (3.9 +/- 3.6). Most patients had suppressed serum iPTH levels of < 10 pg/mL. Plasma PTHrP levels were 0.2-44.0 pmol/L (3.8 +/- 6.8). There were 27 cases (56.3%) that had humoral hypercalcemia of malignancy (HHM) with plasma PTHrP levels of > 1.5 pmol/L, and 22 cases had squamous cell carcinoma. There was no difference in serum cTCa, phosphorus, alkaline phosphatase, and iPTH levels between patients with HHM and non-HHM. In 48 MAHC patients, serum cTCa correlated to plasma PTHrP (r = 0.35, p = 0.029) and to serum iPTH (r = 0.49, p = 0.003). In 25 patients with HHM, a stronger correlation between serum cTCa and serum iPTH (r = 0.55, p = 0.005) but not between serum cTCa and plasma PTHrP levels (r = 0.41, p = 0.05) was observed. Stepwise multiple regression analyses showed that serum iPTH but not plasma PTHrP levels independently correlated to serum cTCa levels (r = 0.39, p = 0.04). CONCLUSION: The clinical manifestations of MAHC observed in the present study were similar to those previously reported. Serum calcium correlated to serum iPTH more strongly than to plasma PTHrP levels. The low but detectable serum iPTH level might play a role in the development of severe MAHC particularly in HHM.

Microalbuminuria in type 2 diabetic patient with hypertension.

The prevalence of microalbuminuria (MAU) was determined in type 2 diabetic patients with hypertension attending at the Outpatient Department from October 2002 to November 2003. Nephurฎ tests were performed in all cases to detect macroalbuminuria. Patients without any documented urinalysis or those with normoalbuminuria tested previously were enrolled. Demographic and clinical data were collected through questionnaires. Micralฎ tests were subsequently carried out in those who did not have macroalbuminuria. A hundred males (aged of 59.3 + 11.0 years) and 200 females (aged of 60.3 + 10.1 years) were enrolled with the mean BMI of 27.3+ 4.3 kg/m2 (26.9 + 4.1 kg/m2 in males and 27.6 + 4.4 kg/m2 in females). It was found that he prevalence of macroalbuminuria was 7.3% (22/300), 10% in males and 6% in females (p = 0.78), while the prevalence of MAU was 40.7% (113/278), 48.9% in males and 36.7% in females (p = 0.0001). There was no significant differences between patients with normoalbuminuria and those with MAU in age, sex, ethnic, BMI, levels of BP, fasting plasma glucose, glycosylated hemoglobin, creatinine, LDL-C, HDL-C, including the rate of BP normalization recommended by ADA 2003 guidelines and the use of ACE inhibitors or angiotensin receptor blockers. The prevalence of MAU rose in relation with the duration of diabetes of 1 to 5 years (35.5%), >5 to 10 years (50.0%), and > 10 years (63.2%) as well as with an increase in duration of hypertension, i.e. 1 to 5 years (36.0%), > 5 to 10 years (42.0%), and > 10 years (51.0%). Average number of antihypertensive drugs taken was 2.5 + 1.1 to keep the mean BP of 137.5 + 12.3/80.6 + 7.8 mm Hg.

Prevalence of erectile dysfunction among treated hypertensive males.

OBJECTIVE: Study the prevalence rate of erectile dysfunction (ED) in treated hypertensive males. MATERIAL AND METHOD: Four hundred and twenty nine patients attending the outpatient clinic at Siriraj Hospital between April 2001 and October 2002 were interviewed. The International Index of Erectile Function, a 5-item version (IIEF-5) questionnaire was used. All questions were carried out by a well-trained interviewer. RESULT: Of the 429 patients (mean age of 57.5 +/- 12.0 years) interviewed, 241 cases (56.2%) reported ED. The prevalence was found to increase with age: from 0% in men aged < 40 years, 47.4% in men aged 40-59 years, and 75.3% in men aged > 60 years. Risk of ED was significantly (p < 0. 01) associated with the elderly (OR = 4.7, 95%CI= 3.1-7.1), patients who suffered from hypertension longer than 5 years (OR = 4.0, 95%CI = 2.6-6.1), those with a history of back/pelvic surgery (OR = 2.8, 95%CI = 1.4-4.8), smoking (OR = 1.5, 95%CI = 1.0-2.2), alcohol ingestion (OR = 2.0, 95%CI = 1.3-3.0), diabetes mellitus (OR = 6.3, 95%CI = 3.5-11.2), diuretics (OR = 1.9, 95%CI = 1.3-2.8), and alpha-2 agonist (OR = 7.9, 95%CI = 2.3-26.1) usage. On multivariate regression analyses, the elderly (OR = 4.0, 95%CI = 2.5-6.4), diabetes mellitus (OR = 6.4, 95%CI = 3.5-11.8), the usage of diuretic (OR = 2.1, 95%CI = 1.3-3.4), and alpha-2 agonist (OR = 6.0, 95%CI = 1.7-21.3) predicted ED (p < 0.005 in all categories). Neither history of back/pelvic operation, smoking, alcohol ingestion, overweight (BMI > or = 30 kg/m2), or any other antihypertensive medications independently predicted ED. CONCLUSION: Our results indicated that ED in male hypertensive patients is common and the cause should be sought and avoided. Diabetic patients or those who have been using diuretic or alpha-2 agonists should receive much attention and be routinely evaluated for ED.

Hypertension study among attendants at the Board of Investment Fair 2000.

To study the prevalence of hypertension, blood pressure (BP) controlled and cardiovascular risk factors in people who attended the Board of Investment 2002 Fair (BOI Fair). Altogether 1,774 participants aged more than 15 years old voluntarily participated in BP check-ups during the 3rd-17th February 2000 at the BOI Fair. Three hundred and fifty participants (19.7%) were known cases of hypertension (HT) and 340 participants (19.2%) were newly diagnosed hypertension cases (NHT). Of the HT group, 216 cases were under current treatment (61.7%) and only 69 cases (31.9%) had adequate BP control. Of the NHT group, cardiovascular risk factors were found more frequently than in normotensive participants. This study indicates the necessity of building up awareness in the population, improving in clinical detection, effectively controlling of the risk factors and the normalization of BP. This might prevent hypertension and reduce the cardiovascular disease.

The efficacy and tolerability of an angiotensin II receptor blocker, telmisartan, in Thai patients with mild to moderate essential hypertension.

This open-labeled single-blinded study was performed to evaluate the efficacy and tolerability of telmisartan in the treatment of mild to moderate essential hypertension. Each patient was assigned to take a placebo for 4 weeks followed by once daily-titrated telmisartan (40-80 mg) for 8 weeks. "Office BP" and "24-hour ambulatory BP" measurements (24-h ABPM) were recorded as scheduled. Thirty-one patients (10 males: 21 females) with a mean age of 48.1 years were enrolled. The final SBP/DBP reductions of 14.6 +/- 14.2/9.9 +/- 6.2 mm Hg were obtained. Full response defined as office DBP reduction of > or = 10 mm Hg from baseline and/or DBP < 90 mm Hg was achieved in 73.3 per cent of cases. Excluding 5 cases of white coat HT diagnosed by 24-h ABPM, full response rate (DBP reduction of > or = 10 mm Hg from baseline and/or < 85 mm Hg) was 76 per cent. Trough to peak ratio and smoothness index for SBP/DBP were highly acceptable (0.75/0.76 and 0.97/1.01, respectively). There were 4 cases of adverse events (2 cases of dizziness, 1 case of headache, and 1 case of acute myocardial infarction).

Adrenal cortical carcinoma presenting as liver abscess: Report of a case.

A 60 year-old woman presented with clinical signs and symptoms of liver abscess. She had a cystic mass on the right lobe of the liver. Liver needle aspiration was performed and anchovy-paste like material was obtained. She recovered after treatment with oral metronidazole even though investigations for Entamoeba histolytica were negative. Two and a half years later, she returned with the same clinical signs and symptoms. Liver needle aspirations were performed many times and the same anchovy-paste like material was obtained but no definite diagnosis was made. Finally, laparotomy showed an extrahepatic retroperitoneal cystic mass of the right adrenal gland adjacent to the liver. Intravenous pyelography, adrenal CT scan and adrenal angiography were performed. The tumor was removed and the final histopathological diagnosis was adrenal cortical carcinoma.