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| ==Differential Diagnosis== | | ==Differential Diagnosis== |
| Sarcoidosis has many differentials, which can be classified depending on the organ involved.<ref>Samter's immunologic diseases.—6th ed./[edited by] K. Frank Austen … [et al.]</ref>
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|
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| '''Lung'''<ref name="pmid1871095">{{cite journal| author=Khomenko AG| title=[Diagnosis of granulomatous lung diseases]. | journal=Probl Tuberk | year= 1991 | volume= | issue= 3 | pages= 5-9 | pmid=1871095 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1871095 }} </ref>
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|
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| 1.Tuberculosis 2.Atypical Mycobacteriosis 3.Cryptococcosis 4.Aspergillosis 5.Aspiration of foriegn materials
| |
| 6.Blastomycosis 7.Pneumocystitis carinii 8.Pneumoconiosis 9.Drug reactions 10.Hypersensitivity pneumonitis
| |
| 11.Drug reactions12..Histoplasmosis 13.Chronic interstitial pneumonia
| |
| 14.Necrotizing sarcoid granulomatosis 15.Wegner's granulomatosis
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|
| |
| '''Lymph Node'''
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|
| |
| 1.Tuberculosis 2.Atypical Mycobacteriosis 3.Brucellosis 4.GLUS syndrome 5.Cat scratch disease
| |
| 6.Toxoplasmosis 7.Hodgkin disease 8.Non Hodgkin lymphoma 9.Sarcoid reaction in lymph nodes to carcinoma
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| 10.Kikuchi disease(granulomatous histiocytic necrotizing lymphadenitis)
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|
| |
| '''Skin'''
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|
| |
| 1.Tuberculosis 2.Atypical mycobacteriosis 3.Fungal infection 4.Rheumatoid nodules 6.Reaction to foreign bodies
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|
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| '''Liver'''
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|
| |
| 1.Tuberculosis 2.Brucellosis 3.Schitosomiasis 4.Crohn's disease 5.Hodgkin's disease 6. Non hodgkin's lymphoma
| |
| 7.GLUS syndrome 8.Primary biliary cirrhosis
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|
| |
| '''Bone Marrow'''
| |
|
| |
| 1.Tuberculosis 2.Histoplasmosis 3.Cytomegalovirus 4.Drugs 5.Infectious Mononucleosis 6.GLUS syndrome
| |
| 7.Hodgkin's disease 8.Non Hodgkin's lymphoma
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|
| |
| '''Other biopsy sites'''
| |
|
| |
| 1.Tuberculosis 2.Brucellosis 3.Crohn's disease 4.GLUS Syndrome 5.Other infections 6.Giant cell myocarditis
| |
|
| |
| ==Differential diagnosis==
| |
|
| |
| {| class="wikitable"
| |
| !Causes of
| |
| lung cavities
| |
| !Differentiating Features
| |
| !Differentiating radiological findings
| |
| !Diagnosis
| |
| confirmation
| |
| |-
| |
| |
| |
| *[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]])<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
| |
| |
| |
| *Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
| |
| *Chronic smokers
| |
| *Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
| |
| *Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
| |
| *[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
| |
| |
| |
| *A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities <ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref> <ref name="pmid16183941">{{cite journal |vauthors=Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM |title=Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome |journal=Radiology |volume=237 |issue=1 |pages=342–7 |year=2005 |pmid=16183941 |doi=10.1148/radiol.2371041650 |url=}}</ref>
| |
| *[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
| |
| |
| |
| *[[Biopsy]] of lung
| |
| |-
| |
| |
| |
| *Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
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| |
| |
| *Mostly in endemic areas
| |
| *Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
| |
| |
| |
| *CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
| |
| |
| |
| *[[Sputum]] smear positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
| |
| |-
| |
| |
| |
| *[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
| |
| |
| |
| *Any age group
| |
| *Acute, [[fulminant]] life threating complication of prior infection
| |
| *>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability
| |
| *Worsening [[pneumonia]]-like symptoms
| |
|
| |
| |
| |
| *CXR demonstrates multiple cavitary lesions
| |
| *[[Pleural effusion]] and [[empyema]] are common findings
| |
| |
| |
| *[[Complete blood count|CBC]] is positive for causative organism
| |
| |-
| |
| |
| |
| *Loculated [[empyema]]
| |
| |
| |
| * Children and elderly are at risk
| |
|
| |
| *Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
| |
| *Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
| |
| |
| |
| *[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
| |
| |
| |
| *[[Thoracocentesis]]
| |
| |-
| |
| |
| |
| *[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
| |
| |
| |
| *Women are more commonly effected than man.<ref name="pmid12541109">{{cite journal |vauthors=Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ |title=Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients |journal=Eur Radiol |volume=13 |issue=1 |pages=43–51 |year=2003 |pmid=12541109 |doi=10.1007/s00330-002-1422-2 |url=}}</ref>
| |
| *Kidneys are also involved
| |
| *Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
| |
| *Lower respiratory tract symptoms, [[hemoptysis]], [[cough]], [[dyspnea]].
| |
| *Renal symptoms, [[hematuria]], red cell [[casts]]
| |
| |
| |
| *Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR
| |
|
| |
| |
| |
| *Positive for [[P-ANCA]]
| |
| *Biopsy of the tissue involved shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
| |
| |-
| |
| |
| |
| *[[Rheumatoid nodule]]
| |
| |
| |
| *Elderly females of 40-50 age group
| |
| *Manifestation of [[rheumatoid arthritis]]
| |
| *Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet with morning stiffness are common manifestations.
| |
| |
| |
| *Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray.
| |
| |
| |
| *Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]]
| |
| |-
| |
| |
| |
| *[[Sarcoidosis]]
| |
| |
| |
| *More common in African-American females
| |
| *Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]<ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |year=2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref>
| |
| *Associated with [[restrictive lung disease]]
| |
| *[[Erythema nodosum]]
| |
| *[[Lupus pernio]] (skin lesions on face resembling lupus)
| |
| *[[Bell's palsy|Bell palsy]]
| |
| *[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
| |
| |
| |
| *On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
| |
| *CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
| |
| *Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref>
| |
| |
| |
| *Biopsy of lung shows non-[[caseating]] [[granuloma]]
| |
| |-
| |
| |
| |
| *[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])<ref name="pmid9724431">{{cite journal |vauthors=Murphy J, Schnyder P, Herold C, Flower C |title=Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma |journal=Eur Radiol |volume=8 |issue=7 |pages=1165–9 |year=1998 |pmid=9724431 |doi=10.1007/s003300050527 |url=}}</ref><ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
| |
| |
| |
| *Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
| |
| *It is caused by [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
| |
| *People working in industries are at high risk
| |
| *Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref>
| |
| |
| |
| *Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.<ref name="pmid8109493">{{cite journal |vauthors=Lee KS, Kullnig P, Hartman TE, Müller NL |title=Cryptogenic organizing pneumonia: CT findings in 43 patients |journal=AJR Am J Roentgenol |volume=162 |issue=3 |pages=543–6 |year=1994 |pmid=8109493 |doi=10.2214/ajr.162.3.8109493 |url=}}</ref>
| |
| |
| |
| *Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
| |
| *[[Pulmonary function tests]] demonstrate low fev1/fvc
| |
| |-
| |
| |
| |
| *[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref>
| |
| |
| |
| *Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
| |
| *Clinical presentation varies, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
| |
| *Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.
| |
| |
| |
| *Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.<ref name="pmid2787035">{{cite journal |vauthors=Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR |title=Pulmonary histiocytosis X: comparison of radiographic and CT findings |journal=Radiology |volume=172 |issue=1 |pages=249–54 |year=1989 |pmid=2787035 |doi=10.1148/radiology.172.1.2787035 |url=}}</ref>
| |
| |
| |
| *Biopsy of the lung
| |
| |}
| |
|
| |
| Sarcoidosis must be differentiated from other diseases that cause [[bone pain]], [[edema]], and [[erythema]].
| |
|
| |
| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| |
| |+
| |
| ! style="background: #4479BA; width: 180px;" | {{fontcolor|#ffffff|Disease}}
| |
| ! style="background: #4479BA; width: 650px;" | {{fontcolor|#ffffff|Findings}}
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" | '''Soft tissue infection'''<br> (Commonly [[cellulitis]])
| |
| | style="padding: 7px 7px; background: #F5F5F5;" | History of skin warmness, swelling and erythema. Bone probing is the definite way to differentiate them.<ref name="pmid8532002">{{cite journal |vauthors=Bisno AL, Stevens DL |title=Streptococcal infections of skin and soft tissues |journal=N. Engl. J. Med. |volume=334 |issue=4 |pages=240–5 |year=1996 |pmid=8532002 |doi=10.1056/NEJM199601253340407 |url=}}</ref><ref name="pmid24947530">{{cite journal |vauthors=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC |title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America |journal=Clin. Infect. Dis. |volume=59 |issue=2 |pages=147–59 |year=2014 |pmid=24947530 |doi=10.1093/cid/ciu296 |url=}}</ref>
| |
| |-
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| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Osteonecrosis]]'''<br>(Avascular necrosis of bone)
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |Previous history of trauma, radiation, use of steroids or biphosphonates are suggestive to differentiate osteonecrosis from ostemyelitis.<ref name="pmid21865285">{{cite journal |vauthors=Shigemura T, Nakamura J, Kishida S, Harada Y, Ohtori S, Kamikawa K, Ochiai N, Takahashi K |title=Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study |journal=Rheumatology (Oxford) |volume=50 |issue=11 |pages=2023–8 |year=2011 |pmid=21865285 |doi=10.1093/rheumatology/ker277 |url=}}</ref><ref name="pmid25480307">{{cite journal |vauthors=Slobogean GP, Sprague SA, Scott T, Bhandari M |title=Complications following young femoral neck fractures |journal=Injury |volume=46 |issue=3 |pages=484–91 |year=2015 |pmid=25480307 |doi=10.1016/j.injury.2014.10.010 |url=}}</ref><br> MRI is diagnostic.<ref name="pmid22022684">{{cite journal |vauthors=Amanatullah DF, Strauss EJ, Di Cesare PE |title=Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management |journal=Am J. Orthop. |volume=40 |issue=9 |pages=E186–92 |year=2011 |pmid=22022684 |doi= |url=}}</ref><ref name="pmid15116601">{{cite journal |vauthors=Etienne G, Mont MA, Ragland PS |title=The diagnosis and treatment of nontraumatic osteonecrosis of the femoral head |journal=Instr Course Lect |volume=53 |issue= |pages=67–85 |year=2004 |pmid=15116601 |doi= |url=}}</ref>
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Charcot arthropathy|Charcot joint]]'''
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |Patients with [[Charcot arthropathy|Charcot joint]] commonly develop skin ulcerations that can in turn lead to secondary osteomyelitis.<br>Contrast-enhanced MRI may be diagnostically useful if it shows a sinus tract, replacement of soft tissue fat, a fluid collection, or extensive marrow abnormalities. Bone biopsy is the definitive diagnostic modality.<ref name="pmid16436821">{{cite journal |vauthors=Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP |title=Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics |journal=Radiology |volume=238 |issue=2 |pages=622–31 |year=2006 |pmid=16436821 |doi=10.1148/radiol.2382041393 |url=}}</ref>
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Bone tumors]]'''
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |May present with local pain and radiographic changes consistent with osteomyelitis. <br>Tumors most likely to mimic osteomyelitis are ''osteoid osteomas'' and ''chondroblastomas'' that produce small, round, radiolucent lesions on radiographs.<ref>{{cite book | last = Lovell | first = Wood | title = Lovell and Winter's pediatric orthopaedics | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2014 | isbn = 978-1605478142 }}</ref>
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Gout]]'''
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |Gout presents with [[joint pain]] and [[swelling]]. Joint aspiration and crystals in synovial fluid is diagnostic for gout.<ref name="pmid20662061">{{cite journal |vauthors=Joosten LA, Netea MG, Mylona E, Koenders MI, Malireddi RK, Oosting M, Stienstra R, van de Veerdonk FL, Stalenhoef AF, Giamarellos-Bourboulis EJ, Kanneganti TD, van der Meer JW |title=Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1β production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis |journal=Arthritis Rheum. |volume=62 |issue=11 |pages=3237–48 |year=2010 |pmid=20662061 |pmc=2970687 |doi=10.1002/art.27667 |url=}}</ref>
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[SAPHO syndrome]]'''<br>(Synovitis, acne, pustulosis, hyperostosis, and osteitis)
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |[[SAPHO syndrome]] consists of a wide spectrum of neutrophilic [[dermatosis]] associated with aseptic osteoarticular lesions. <br>It can mimic osteomyelitis in patients who lack the characteristic findings of pustulosis and [[synovitis]]. <br>The diagnosis is established via clinical manifestations; bone culture is sterile in the setting of [[osteitis]].
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Sarcoidosis]]'''
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |It involves most frequently the pulmonary [[parenchyma]] and mediastinal lymph nodes, but any organ system can be affected. <br>Bone involvement is often bilateral and bones commonly affected include the middle and distal phalanges (producing “sausage finger”), wrist, skull, vertebral column, and long bones.
| |
| |-
| |
| | style="padding: 7px 7px; background: #DCDCDC;" |'''[[Langerhans' cell histiocytosis]]'''
| |
| | style="padding: 7px 7px; background: #F5F5F5;" |The disease usually manifests in the skeleton and solitary bone lesions are encountered twice as often as multiple bone lesions.<br>The tumours can develop in any bone, but most commonly originate in the skull and jaw, followed by vertebral bodies, ribs, pelvis, and long bones.<ref name="pmid26461144">{{cite journal |vauthors=Picarsic J, Jaffe R |title=Nosology and Pathology of Langerhans Cell Histiocytosis |journal=Hematol. Oncol. Clin. North Am. |volume=29 |issue=5 |pages=799–823 |year=2015 |pmid=26461144 |doi=10.1016/j.hoc.2015.06.001 |url=}}</ref>
| |
| |-
| |
| |}
| |
|
| |
| must be differentiated from other causes of hypercalcaemia
| |
|
| |
| {|
| |
| ! colspan="9" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Differential diagnosis of hyperparathyroidism on the basis of hypercalcemia}}
| |
| |-
| |
| ! colspan="2" rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Disorder}}
| |
| ! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Mechanism of hypercalcemia}}
| |
| ! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Clinical features}}
| |
| ! colspan="4" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
| |
| ! rowspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Imaging & diagnostic modalities}}
| |
| |-
| |
| ! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|PTH}}
| |
| ! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Calcium}}
| |
| ! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Phosphate}}
| |
| ! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Other findings}}
| |
| |-
| |
| ! rowspan="3" style="background: #DCDCDC; text-align: center;" |'''Hyperparathyroidism'''
| |
| ! style="background: #DCDCDC; text-align: center;" |Primary hyperparathyroidism
| |
| | style="background: #F5F5F5;" |Increase in [[secretion]] of [[parathyroid hormone]] ([[PTH]]) from a primary process in [[parathyroid gland]]. [[Parathyroid hormone]] causes increase in [[serum]] [[calcium]].
| |
| | style="background: #F5F5F5;" |
| |
| * Usually asymptomatic
| |
| * [[Hypercalcemia]] detected on routine biochemical panel
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↓/Normal
| |
| | style="background: #F5F5F5; text-align: center;" |Normal/↑ calcitriol
| |
| | rowspan="3" style="background: #F5F5F5;" |Findings of bone resorption:
| |
| * [[X-ray]]
| |
| * [[Dual energy X-ray absorptiometry]] ([[DXA]])
| |
| Preoperative localization of hyperfunctioning [[parathyroid gland]]:
| |
| * Non-Invasive
| |
| ** [[Tc-99m sestamibi scintigraphy]]
| |
| ** Neck [[ultrasound]]
| |
| ** 4D-CT
| |
| ** [[SPECT]](P-SPECT)
| |
| ** [[Positron emission tomography|PET]]
| |
| ** [[MRI]]
| |
| * Invasive:
| |
| ** Super sensitive [[venous]] sampling
| |
| ** Selective [[arteriography]]
| |
| ** [[Angiogram|Angiography]]
| |
| Predicting post-operative success:
| |
| * [[Intraoperative parathyroid hormone]] monitoring
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Secondary hyperparathyroidism
| |
| | style="background: #F5F5F5;" |Increase in [[secretion]] of [[parathyroid hormone]] ([[PTH]]) from a secondary process. [[Parathyroid hormone]] causes increase in [[serum]] [[calcium]] after long periods.
| |
| | style="background: #F5F5F5;" |
| |
| * May present with history of:
| |
| ** [[Chronic renal failure]]
| |
| ** [[Vitamin D deficiency]]
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↓/Normal
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Tertiary hyperparathyroidism
| |
| | style="background: #F5F5F5;" |Continuous elevation of [[parathyroid hormone]] (PTH) even after successful treatment of the secondary cause of elevated [[parathyroid hormone]]. [[Parathyroid hormone]] causes increase in serum calcium.
| |
| | style="background: #F5F5F5;" |
| |
| * Usually present with history of [[kidney transplant]]
| |
| * Usually [[hyperplasia]] of all four [[parathyroid glands]]
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| |-
| |
| ! colspan="2" style="background: #DCDCDC; text-align: center;" |[[Familial hypocalciuric hypercalcemia]]
| |
| | style="background: #F5F5F5;" |This is a [[genetic disorder]] caused my [[mutation]] in [[calcium-sensing receptor]] gene.
| |
| | style="background: #F5F5F5;" |
| |
| * A benign condition
| |
| * Does not require treatment
| |
| | style="background: #F5F5F5; text-align: center;" |Normal/↑
| |
| | style="background: #F5F5F5; text-align: center;" |Normal/↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5;" |
| |
| * Urinary calcium/creatinine clearance ratio
| |
| |-
| |
| ! rowspan="4" style="background: #DCDCDC; text-align: center;" |'''Malignancy'''<ref name="pmid26713296">{{cite journal |vauthors=Mirrakhimov AE |title=Hypercalcemia of Malignancy: An Update on Pathogenesis and Management |journal=N Am J Med Sci |volume=7 |issue=11 |pages=483–93 |year=2015 |pmid=26713296 |pmc=4683803 |doi=10.4103/1947-2714.170600 |url=}}</ref>
| |
| ! style="background: #DCDCDC; text-align: center;" |Humoral hypercalcemia of malignancy<ref name="pmid1346019">{{cite journal |vauthors=Ratcliffe WA, Hutchesson AC, Bundred NJ, Ratcliffe JG |title=Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia |journal=Lancet |volume=339 |issue=8786 |pages=164–7 |year=1992 |pmid=1346019 |doi=10.1016/0140-6736(92)90220-W |url=}}</ref><ref name="pmid7962324">{{cite journal |vauthors=Ikeda K, Ohno H, Hane M, Yokoi H, Okada M, Honma T, Yamada A, Tatsumi Y, Tanaka T, Saitoh T |title=Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma |journal=J. Clin. Endocrinol. Metab. |volume=79 |issue=5 |pages=1322–7 |year=1994 |pmid=7962324 |doi=10.1210/jcem.79.5.7962324 |url=}}</ref><ref name="pmid12679445">{{cite journal |vauthors=Horwitz MJ, Tedesco MB, Sereika SM, Hollis BW, Garcia-Ocaña A, Stewart AF |title=Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1-36) [hPTHrP-(1-36)] versus hPTH-(1-34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers |journal=J. Clin. Endocrinol. Metab. |volume=88 |issue=4 |pages=1603–9 |year=2003 |pmid=12679445 |doi=10.1210/jc.2002-020773 |url=}}</ref>
| |
| | style="background: #F5F5F5;" |[[Tumor]] cells secretes [[parathyroid hormone-related protein]] ([[PTHrP]]) which has similar action as [[parathyroid hormone]].
| |
| | style="background: #F5F5F5;" |
| |
| * Most common cause of [[malignancy]] related [[hypercalcemia]]
| |
| * Usually present with [[solid tumors]]
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↓/Normal
| |
| | style="background: #F5F5F5; text-align: center;" |↑ [[PTHrP]]
| |
|
| |
| Normal/↑ calcitriol
| |
| | style="background: #F5F5F5;" |
| |
| * [[Chest X-rays|Chest X-ray]]
| |
| * [[CT scan]]
| |
| * [[MRI]]
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Osteolytic tumors
| |
| | style="background: #F5F5F5;" |[[Multiple myeloma]] produces [[osteolysis]] of [[bones]] causing [[hypercalcemia]]. [[Osteolytic metasteses]] can cause [[bone resorption]] causing [[hypercalcemia]].
| |
| | style="background: #F5F5F5;" |
| |
| * Commonly present in [[multiple myeloma]] and [[breast cancer]]
| |
| | style="background: #F5F5F5; text-align: center;" |↓
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5;" |
| |
| * [[DXA]]
| |
| * [[X-ray]]
| |
| * [[Mammography]]
| |
| * [[Ultrasound]]
| |
| * [[ESR]]
| |
| * [[Serum protein electrophoresis]]
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Production of calcitirol
| |
| | style="background: #F5F5F5;" |Some tumors has ectopic activity of 1-alpha-hydroxylase leading to increased production of [[calcitriol]]. [[Calcitriol]] is active form of [[vitamin D]] and causes [[hypercalcemia]].
| |
| | style="background: #F5F5F5;" |
| |
| * Commonly present in [[lymphomas]] and in some [[Ovarian cancer|ovarian germ cell tumors]]
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑ [[Calcitriol]]
| |
| | style="background: #F5F5F5;" |
| |
| * [[CT scan]]
| |
| * [[MRI]]
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Ectopic parathyroid hormone<ref name="pmid16263810">{{cite journal |vauthors=VanHouten JN, Yu N, Rimm D, Dotto J, Arnold A, Wysolmerski JJ, Udelsman R |title=Hypercalcemia of malignancy due to ectopic transactivation of the parathyroid hormone gene |journal=J. Clin. Endocrinol. Metab. |volume=91 |issue=2 |pages=580–3 |year=2006 |pmid=16263810 |doi=10.1210/jc.2005-2095 |url=}}</ref>
| |
| | style="background: #F5F5F5;" |Some tumors leads to [[Ectopia|ectopic]] production of [[parathyroid hormone]].
| |
| | style="background: #F5F5F5;" |
| |
| * In rare instances, [[small cell carcinoma of lung]] may produce [[hypercalcemia]] by this process
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↓/Normal
| |
| | style="background: #F5F5F5; text-align: center;" |Normal/↑ [[calcitriol]]
| |
| | style="background: #F5F5F5;" |
| |
| * [[Chest X-rays|Chest X-ray]]
| |
| * [[CT scan]]
| |
| * [[MRI]]
| |
| |-
| |
| ! rowspan="2" style="background: #DCDCDC; text-align: center;" |'''Medication induced'''
| |
| ! style="background: #DCDCDC; text-align: center;" |Lithium<ref name="pmid2918061">{{cite journal |vauthors=Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S |title=Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume |journal=J. Clin. Endocrinol. Metab. |volume=68 |issue=3 |pages=654–60 |year=1989 |pmid=2918061 |doi=10.1210/jcem-68-3-654 |url=}}</ref>
| |
| | style="background: #F5F5F5;" |[[Lithium]] lowers [[Urinary System|urinary]] [[calcium]] and causes [[hypercalcemia]]. [[Lithium]] has been reported to cause an increase in [[parathyroid hormone]] and enlargement if [[parathyroid gland]] after weeks to months of therapy.
| |
| | style="background: #F5F5F5;" |
| |
| * History of [[mood disorder]]
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5;" |
| |
| * [[Lithium]] levels
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Thiazide diuretics
| |
| | style="background: #F5F5F5;" |[[Thiazide diuretics]] lowers [[urinary]] [[calcium]] [[excretion]] and causes [[hypercalcemia]].
| |
| | style="background: #F5F5F5;" |
| |
| * History of [[cardiac]] disorder
| |
| * Rarely causes [[hypercalcemia]]
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5;" | --
| |
| |-
| |
| ! rowspan="2" style="background: #DCDCDC; text-align: center;" |'''Nutritional'''
| |
| ! style="background: #DCDCDC; text-align: center;" |Milk-alkali syndrome
| |
| | style="background: #F5F5F5;" |[[Hypercalcemia]] is be caused by high intake of [[calcium carbonate]].
| |
| | style="background: #F5F5F5;" |
| |
| * History of
| |
| ** High milk intake
| |
| ** Excess calcium intake for treating:
| |
| *** [[Osteoporosis]]
| |
| *** [[Dyspepsia]]
| |
| * May lead to [[metabolic alkalosis]] and [[renal insufficiency]].
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5;" |
| |
| * [[Renal function tests]]
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |Vitamin D toxicity
| |
| | style="background: #F5F5F5;" |Excess [[vitamin D]] causes increased [[absorption]] of [[calcium]] from [[intestine]] causing [[hypercalcemia]].
| |
| | style="background: #F5F5F5;" |
| |
| * History of:
| |
| ** Excess intake [[vitamin D]]
| |
| ** Excess milk fortified with [[vitamin D]]<ref name="pmid1313547">{{cite journal |vauthors=Jacobus CH, Holick MF, Shao Q, Chen TC, Holm IA, Kolodny JM, Fuleihan GE, Seely EW |title=Hypervitaminosis D associated with drinking milk |journal=N. Engl. J. Med. |volume=326 |issue=18 |pages=1173–7 |year=1992 |pmid=1313547 |doi=10.1056/NEJM199204303261801 |url=}}</ref>
| |
| ** Topical application of vitamin D analogue [[calcipotriol]]<ref name="pmid8120527">{{cite journal |vauthors=Hoeck HC, Laurberg G, Laurberg P |title=Hypercalcaemic crisis after excessive topical use of a vitamin D derivative |journal=J. Intern. Med. |volume=235 |issue=3 |pages=281–2 |year=1994 |pmid=8120527 |doi= |url=}}</ref>
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑ [[Vitamin D]] ([[calcidiol]] and/or [[calcitriol]])
| |
| | style="background: #F5F5F5;" | --
| |
| |-
| |
| ! style="background: #DCDCDC; text-align: center;" |'''Granulomatous disease'''
| |
| ! style="background: #DCDCDC; text-align: center;" |Sarcoidosis<ref name="pmid9215298">{{cite journal |vauthors=Dusso AS, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S, Slatopolsky E |title=gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses |journal=J. Clin. Endocrinol. Metab. |volume=82 |issue=7 |pages=2222–32 |year=1997 |pmid=9215298 |doi=10.1210/jcem.82.7.4074 |url=}}</ref>
| |
| | style="background: #F5F5F5;" |[[Hypercalcemia]] is causes by endogeous production of [[calcitriol]] by disease-activated [[Macrophage|macrophages]].
| |
| | style="background: #F5F5F5;" |
| |
| * History of:
| |
| ** [[Cough]]
| |
| ** [[Dyspnea]]
| |
| ** [[Chest pain]]
| |
| ** [[Tiredness]] or [[weakness]]
| |
| ** [[Fever]]
| |
| ** [[Weight loss]]
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑
| |
| | style="background: #F5F5F5; text-align: center;" | --
| |
| | style="background: #F5F5F5; text-align: center;" |↑ [[Calcitriol]]
| |
|
| |
| ↑ [[ACE]] levels
| |
| | style="background: #F5F5F5;" |
| |
| * [[Chest X-ray]]
| |
| * [[Biopsy]]
| |
| |}
| |
|
| |
| Sarcoidosis must be differentiated from other causes of diabetes insipidus.
| |
| {| class="wikitable"
| |
| !Type of DI
| |
| !Subclass
| |
| !Disease
| |
| !Defining signs and symptoms
| |
| !Lab/Imaging findings
| |
| |-
| |
| | rowspan="5" |Central
| |
| | rowspan="3" |Acquired
| |
| |[[Histiocytosis]]
| |
| |
| |
| * Bone lysis and [[Bone fracture|fracture]]
| |
| * Purulent [[otitis media]]
| |
| * [[Diabetes insipidus]] and delayed puberty
| |
| * [[Maxillary]], [[mandibular]], and [[gingival]] disease
| |
| * [[Rash]] and [[Erythematous|maculoerythematous]] skin lesions
| |
| * Scaly, [[erythematous]] scalp patches
| |
| * [[Lung]] involvement
| |
| * [[GI bleeding]]
| |
| * [[Lymphadenopathy|Lymph node enlargement]]<ref name="pmid1340034">{{cite journal| author=Ghosh KN, Bhattacharya A| title=Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory. | journal=Rev Inst Med Trop Sao Paulo | year= 1992 | volume= 34 | issue= 2 | pages= 181-2 | pmid=1340034 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1340034 }} </ref>
| |
| |
| |
| * CD1a and CD45 +
| |
| * Interleukin-17 (ILITA)
| |
| [[Image:Langerhans Skull X ray.jpg|center|300px|thumb|Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459]]
| |
| |-
| |
| |[[Craniopharyngioma]]
| |
| |
| |
| * [[Headache]]
| |
| * [[Endocrine disorders|Endocrine dysfunction]]
| |
| ** [[Diabetes insipidus]]
| |
| ** [[Hypothyroidism]]
| |
| ** [[Adrenal failure]]
| |
| ** [[Diabetes insipidus]] (e.g., excessive fluid intake and urination)
| |
| ** Growth failure and [[delayed puberty]]
| |
| |
| |
| * [[Suprasellar]] calcified cyst on [[MRI]]
| |
| [[Image:Craniopharyngioma-papillary-1.jpg|center|300px|thumb|Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812]]
| |
| |-
| |
| |[[Sarcoidosis]]
| |
| |
| |
| * Systemic complaints
| |
| ** [[Fever]]
| |
| ** [[Anorexia]]
| |
| ** [[Arthralgias]]
| |
| * Pulmonary complaints
| |
| ** [[Dyspnea on exertion]]
| |
| ** [[Cough]]
| |
| ** Chest pain,
| |
| ** [[Hemoptysis]] (rare)
| |
| * [[Diabetes mellitus]]
| |
| |
| |
| * [[Hypercalcemia]]
| |
| * [[Hypercalciuria]] ([[Granulomas|noncaseating granulomas]])
| |
| * Elevated [[alkaline phosphatase]]
| |
| * [[Serum amyloid A]] (SAA)
| |
| * [[Angiotensin-converting enzyme|ACE]] levels may be elevated
| |
| [[Image:Neurosarcoidosis.jpg|center|300px|thumb|Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930]]
| |
| |-
| |
| | rowspan="2" |Congenital
| |
| |[[Hydrocephalus]]
| |
| |
| |
| * Cognitive deterioration
| |
| * [[Headaches]]
| |
| * [[Neck pain]]
| |
| * [[Blurred vision]]
| |
| * [[Unsteady gait]]
| |
| * [[Incontinence]] such as [[polyuria]]
| |
| |Dilated [[ventricles]] on [[Computed tomography|CT]] and [[Magnetic resonance imaging|MRI]]
| |
| [[Image:Obstructive-hydrocephalus.jpg|center|300px|thumb|Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453]]
| |
| |-
| |
| |[[Wolfram syndrome|Wolfram Syndrome]] (DIDMOAD)
| |
| |
| |
| * [[Diabetes insipidus|Diabetes Insipidus]]
| |
| * [[Diabetes mellitus|Diabetes Mellitus]]
| |
| * [[Optic atrophy|Optic Atrophy]]
| |
| * [[Deafness]]
| |
| |
| |
| * Negative [[islet cell]] antibodies
| |
| * [[Optic atrophy]] on [[electroretinogram]]
| |
| * [[Deafness]] on [[audiogram]]
| |
| * [[Atrophy]] of brain stem on [[Magnetic resonance imaging|MRI]]
| |
| |-
| |
| | rowspan="5" |[[Nephrogenic diabetes insipidus|Nephrogenic]]
| |
| | rowspan="5" |[[Acquired disorder|Acquired]]
| |
| |Drug-induced ([[demeclocycline]], [[lithium]])
| |
| |
| |
| * [[Polyuria]]
| |
| * [[Polydipsia]]
| |
| * [[Nocturia]]
| |
| |
| |
| * [[Urine osmolality]] <100 mmol/
| |
| * [[Arginine vasopressin]] level >4.6 pmol/
| |
| * Little or no response to administration of exogenous [[arginine vasopressin]]
| |
| |-
| |
| |[[Hypercalcemia]]
| |
| |
| |
| * [[Polyuria]]
| |
| * [[Polydipsia]]
| |
| * [[Gastrointestinal]] disturbances
| |
| * [[Bone fracture|Pathological fractures]]
| |
| * [[Confusion]]
| |
| * [[Palpitations]] and [[cardiac arrhythmias]]
| |
| |
| |
| * Ca levels greater than 11 meq/L
| |
| |-
| |
| |[[Hypokalemia]]
| |
| |
| |
| * [[Polyuria]]
| |
| * [[Hyporeflexia]]
| |
| * [[Palpitations]] and [[cardiac arrhythmias]]
| |
| |
| |
| * K levels less than 3meq/L on CBC
| |
| |-
| |
| |[[Multiple myeloma]]
| |
| |
| |
| * Pathologic [[bone fractures]]
| |
| * [[Bleeding]]
| |
| * [[Hypercalcemia]] leading to [[polyuria]]
| |
| * [[Infection]]
| |
| * [[Hyperviscosity]]
| |
| * [[Anemia]]
| |
| |
| |
| * [[IgG]] or [[IgA]] spike on [[serum protein electrophoresis]]
| |
| * [[Monoclonal antibody|Monoclonal M spike]]
| |
| * Disordered [[plasma cell]] proliferation on [[bone marrow biopsy]]
| |
| [[Image:Multiple-myeloma-skeletal-survey.jpg|center|300px|thumb|Skeletal survey in a patient with multiple myeloma showing multiple lytic lesions - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7682]]
| |
| |-
| |
| |[[Sickle-cell disease|Sickle cell disease]]
| |
| |
| |
| * [[Chronic pain]]
| |
| * [[Anemia]]
| |
| * [[Aplastic crisis]]
| |
| * Splenic sequestration
| |
| * [[Infection]]
| |
| * [[Isosthenuria]] presenting with [[polyuria]]
| |
| |
| |
| * [[Hemoglobin]] level is 5-9 g/dL
| |
| * [[Hematocrit]] is decreased to 17-29%
| |
| * [[Peripheral blood smear|Peripheral blood smears]] demonstrate [[Target cell|target cells]], elongated cells, and characteristic sickle erythrocytes
| |
| * MRI can demonstrate [[avascular necrosis]] of the [[femoral]] and [[humeral]] heads
| |
| [[Image:Sickle cells.jpg|center|300px|thumb|Blood film showing the sickle cells - By Dr Graham Beards - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18421017]]
| |
| |-
| |
| | colspan="2" |Primary polydipsia
| |
| |[[Psychogenic]]
| |
| |
| |
| * [[Polyuria]]
| |
| * [[Polydipsia]]
| |
| * [[Nocturia]]
| |
| |
| |
| * Dry mucus membrane
| |
| * History of [[psychiatric disorders]]
| |
| |-
| |
| | colspan="3" |Gestational diabetes insipidus
| |
| |
| |
| * [[Polyuria]]
| |
| * [[Polydipsia]]
| |
| * [[Nocturia]]
| |
| * [[Pregnancy]]
| |
| |
| |
| * Dry mucus membranes
| |
| * [[Pregnancy]]
| |
| |-
| |
| | colspan="3" |[[Diabetes mellitus]]
| |
| |
| |
| * [[Polyuria]]
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| * [[Polydipsia]]
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| * [[Nocturia]]
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| * [[Weight gain (patient information)|Weight gain]]
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| |
| |
| * Elevated blood sugar levels >126
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| * Elevated [[HbA1c]] > 6.5
| |
| |}
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|
| |
| ==References==
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| {{Reflist|2}}
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|
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| [[Category:Pulmonology]]
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| [[Category:Rheumatology]]
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|
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| {{WH}}
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| {{WS}}
| |