0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Calcium and Phosphate Metabolism in Tumoral Calcinosis

PAUL D. MITNICK, M.D.; STANLEY GOLDFARB, M.D.; EDUARDO SLATOPOLSKY, M.D.; JACOB LEMANN Jr., M.D.; RICHARD W. GRAY, M.D.; and ZALMAN S. AGUS, M.D.
[+] Article and Author Information

Grant support: in part by NIH Research Grants from the National Heart, Lung, and Blood Institute (HL00340) and the National Institute of Arthritis, Metabolism, and Digestive Diseases (AM 19478 and AM 15089); NIH Clinical Research Center Grants 5-M01-RR0040 and RR00058; and NIH Training Grant T-32-AM07006. Dr. Agus is the recipient of Research Career Development Award K04-AM00258, and Dr. Goldfarb is the recipient of NIH Clinical Investigator Award 1-K08-AM00414.

▸Requests for reprints should be addressed to Stanley Goldfarb, M.D.; 860 Gates Pavilion, Hospital of the University of Pennsylvania, 3400 Spruce Street; Philadelphia, PA 19104.


Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and St. Louis, Missouri


© 1980 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1980;92(4):482-487. doi:10.7326/0003-4819-92-4-482
Text Size: A A A

We have recently seen a patient with tumoral calcinosis, a syndrome comprising hyperphosphatemia, normocalcemia, normal glomerular filtration rate (GFR), and extensive periarticular calcific masses. Parathyroid hormone (PTH) deficiency or target organ resistance was ruled out by demonstration of normal serum PTH and urinary 3′5′ cyclic AMP excretion and normal response to exogenous PTH and to endogenous stimulation by ethylenediaminetetraacetate. An intrinsic proximal tubular defect allowing enhanced renal PO4 reabsorption was probably present because there was no phosphaturic response to acetazolamine and renal PO4 threshold remained abnormally elevated even after PTH infusion. We then studied the mechanism by which serum calcium level is maintained in the normal range despite hyperphosphatemia and absence of secondary hyperparathyroidism. Normal 1,25-(OH)2 vitamin D was found, suggesting normal gastrointestinal calcium absorption. This, combined with markedly reduced urinary calcium excretion, perhaps a direct effect of hyperphosphatemia, may maintain calcium balance and prevent secondary hyperparathyroidism. A rise in urinary cyclic AMP excretion after furosemide-induced calciuria supports this hypothesis.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)