Hypercalcemia differential diagnosis: Difference between revisions

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* [[Vitamin D]] [[metabolic disorders]]
* [[Vitamin D]] [[metabolic disorders]]
* [[William's syndrome]]
* [[William's syndrome]]
Hypercalcemia 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]]
* [[Polydipsia]]
* [[Nocturia]]
* [[Weight gain (patient information)|Weight gain]]
|
* Elevated blood sugar levels >126
* Elevated [[HbA1c]] > 6.5
|}


==References==
==References==

Revision as of 15:57, 17 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Overview

Differential Diagnosis

(In alphabetical order)

Hypercalcemia must be differentiated from other causes of diabetes insipidus.

Type of DI Subclass Disease Defining signs and symptoms Lab/Imaging findings
Central Acquired Histiocytosis
  • CD1a and CD45 +
  • Interleukin-17 (ILITA)
Skull x-ray of a patient with Langerhan's histiocytosis showing lytic lesions - Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 9459
Craniopharyngioma
Brain MRI showing suprasellar mass consistent with the diagnosis of craniopharyngioma - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 16812
Sarcoidosis
Contrast-enhanced patches in a patient previously diagnosed with lung sarcoidosis - Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 10930
Congenital Hydrocephalus Dilated ventricles on CT and MRI
Obstructive hydrocephalus showing dilated lateral ventricles - Case courtesy of Dr Paul Simkin, Radiopaedia.org, rID: 30453
Wolfram Syndrome (DIDMOAD)
Nephrogenic Acquired Drug-induced (demeclocycline, lithium)
Hypercalcemia
  • Ca levels greater than 11 meq/L
Hypokalemia
  • K levels less than 3meq/L on CBC
Multiple myeloma
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
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
Primary polydipsia Psychogenic
Gestational diabetes insipidus
Diabetes mellitus
  • Elevated blood sugar levels >126
  • Elevated HbA1c > 6.5

References

  1. ↑ Ghosh KN, Bhattacharya A (1992). "Gonotrophic nature of Phlebotomus argentipes (Diptera: Psychodidae) in the laboratory". Rev Inst Med Trop Sao Paulo. 34 (2): 181–2. PMID 1340034.

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