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Horm Metab Res 2020; 52(09): 689-690
DOI: 10.1055/a-1220-6971
Letter to the Editor

Severe Hypocalcemia and Transient Hypoparathyroidism After Hyperthermic Intraperitoneal Chemotherapy

Senthuran Tharmalingam
1   Fox Chase Cancer Center, Philadelphia, USA
,
Sanjay Reddy
1   Fox Chase Cancer Center, Philadelphia, USA
,
Pankaj Sharda
1   Fox Chase Cancer Center, Philadelphia, USA
,
Christian A. Koch
1   Fox Chase Cancer Center, Philadelphia, USA
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Dear Editors,

Hypocalcemia is not unusual in patients hospitalized for critical illness and has also been described after general surgery in addition to head and neck surgical procedures [1] [2] [3]. Hypocalcemic events commonly occur in the setting of massive blood transfusion, albumin deficiency, vitamin D deficiency, and/or hypomagnesemia. In the absence of these factors, only slight decreases in calcium levels within the normal range have been reported during surgical procedures [1]. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) causing asymptomatic hypocalcemia has only been reported in two previous studies [4] [5]. The etiology is unclear. We here report a patient who developed severe symptomatic hypocalcemia likely as a result of a profound inflammatory reaction with transient hypoparathyroidism after HIPEC.



Publication History

Article published online:
07 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Lepage R, Legare G, Racicot C. et al. Hypocalcemia induced during major and minor abdominal surgery in humans. J Clin Endocrinol Metab 1999; 84: 2254-2258
    CrossrefPubMedGoogle Scholar
  • 2 Padmakumar AV. Intensive care management of patient after cytoreductive surgery and HIPEC – A concise review. Indian J Surg Oncol 2016; 7: 244-248
    CrossrefPubMedGoogle Scholar
  • 3 Khan AA, Koch CA, Van Uum SHM. et al. Standards of care for hypoparathyroidism in adults: A Canadian and International Consensus. Eur J Endocrinol 2019; 180: P1-P22
    CrossrefPubMedGoogle Scholar
  • 4 Diaz-Montes TP, Velez-Meija C, Sittig M. et al. Electrolyte and hematological abnormalities in patients with advanced epithelial ovarian cancers treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) or neoadjuvant chemotherapy plus CRS/HIPEC. Gynecol Oncol 2019; 154 (Suppl. 01) 144 (abstract 1531)
    CrossrefPubMedGoogle Scholar
  • 5 Kapoor R, Robinson KA, Cata JP. et al. Assessment of nephrotoxicity associated with combined cisplatin and mitomycin C usage in laparoscopic hyperthermic intraperitoneal chemotherapy. Int J Hyperther 2019; 36: 492-497
    CrossrefPubMedGoogle Scholar
  • 6 Birrer G, Alban R. Hypocalcemia – an adverse effect of massive blood transfusion examined. J Surg Res 2016; 202: 182-187
    CrossrefPubMedGoogle Scholar
  • 7 Kelly A, Levine MA. Hypocalcemia in the critically Ill patient. J Intens Care Med 2013; 28: 166-177
    CrossrefPubMedGoogle Scholar
  • 8 Vervoort G, Graafsma S. Transient hypoparathyroidism in a patient with fever. Netherl J Med 1994; 44: 95-98
    PubMedGoogle Scholar
  • 9 Canaff L, Hendy G. Calcium sensing receptor gene transcription is up-regulated by the proinflammatory cytokine, interleukin-1B. J Biol Chem 2005; 280: 14177-14188
    CrossrefPubMedGoogle Scholar
  • 10 Canaff L, Zhou X, Hendy GN. The proinflammatory cytokine, interleukin-6, upregulates calcium-sensing receptor gene transcription via Stat1/3 and Sp1/3. J Biol Chem 2008; 283: 13586-13600
    CrossrefPubMedGoogle Scholar
  • 11 Roth L, Eshmuminov D, Laminger F. et al. Systemic inflammatory response after hyperthermic intraperitoneal chemotherapy (HIPC): The perfusion protocol matters!. Eur J Surg Oncol 2019; 45: 1734-1739
    CrossrefPubMedGoogle Scholar
  • 12 Coccolini F, Corbella D, Finazzi P. et al. Time course of cytokines, hemodynamic and metabolic parameters during hyperthermic intraperitoneal chemotherapy. Minerva Anestesiol 2016; 82: 310-319
    PubMedGoogle Scholar
  • 13 De Witte P, de Witte C, Bruins P. Inflammatory response and optimalisation of perioperative fluid administration during hyperthermic intraoperative intraperitoneal chemotherapy surgery. J Gastrointest Oncol 2019; 10: 244-253
    CrossrefPubMedGoogle Scholar
  • 14 Eshmuminov D, Lehmann K. Pathophysiology of inflammation after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. ClinicalTrials.gov Identifier: NCT02741167
  • 15 Coudenys E, Van Meerhaeghe T, Unuane D. et al. Long-term treatment with calcitriol in postsurgical hypoparathyroidism leads to renal function decline. Horm Metab Res 2019; 51: 362-366
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Gao X, Yamazaki Y, Tezuka Y. The effect of extracellular calcium metabolism on aldosterone biosynthesis in physiological and pathological status. Horm Metab Res 2020; 52: 448-453
    Google Scholar
  • 17 Koch C, Papadopoulou-Marketou N, Chrousos GP. Overview of Endocrine Hypertension. 2020 Feb 4. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–.Endotext. 2000–. PMID: 25905214