Thank you Red_Star for your ideas-some of which my research did not turn up. Most of which the doctors ruled out. I am intrigued with the cat scratch disease idea..... hmmmm We shall see.. Thank you again.
The causes of hypercalcemia needs a few spaces. :)
Most common (malignancy and primary hyperparathyroidism account for 90% of hypercalcemic patients):
Primary hyperparathyroidism
Malignant disease:
- PTH-related protein (carcinoma of lung, esophagus, head and neck,
renal cell, breast, ovary, and bladder)
- Ectopic production of 1,25-dihydroxyvitamin D (lymphoma)
- Lytic bone metastases (multiple myeloma, hematologic
malignancies and breast carcinoma)
- Other factor(s) produced locally or ectopically
Uncommon:
Endocrine disorders:
- Thyrotoxicosis
Granulomatous diseases:
- Sarcoidosis
- HIV
Drug-induced:
- Vitamin D
- Thiazide diuretics
- Lithium
- Estrogens and antiestrogens
- Androgens (breast cancer therapy)
- Aminophylline
- Vitamin A
- Aluminum intoxication (in chronic renal failure)
Miscellaneous:
- Immobilization
- Renal failure (acute and chronic)
- Total parenteral nutrition
Rare:
Endocrine disorders:
- Pheochromocytoma
- Vasoactive intestinal polypeptide-producing tumor
- Familial hypocalciuric hypercalcemia
Granulomatous diseases:
- Tuberculosis
- Histoplasmosis
- Coccidioidomycosis
- Leprosy
Miscellaneous:
- Milk-alkali syndrome
- Hypophosphatasia
- William’s syndrome
- Rhabdomyolysis (presentation is usually preceded by a hypocalcemic
state)
Hypercalcemia of malignancy virtually always show low or undetectable levels of intact PTH. Rarely, low or undetectable levels of intact PTH with hypercalcaemia can be due to primary hyperparathyroidism with parathyroid adenomas.
One study concludes the diagnosis of primary hyperparathyroidism should be pursued despite suppressed or low-normal serum intact PTH levels after carefully excluding other causes of hypercalcaemia. "Very low or undetectable intact parathyroid hormone levels in patients with surgically verified parathyroid adenomas." PMID: 18284640.
Another study documents a rare case of isolated granulomatous disease of the spleen presenting as hypercalcemia. The conclusion stated sarcoidosis should be kept in mind as a cause of unexplained hypercalcemia. " 'Surgical cure' for non-parathyroid hypercalcemia." - PMID: 19254358.
A variety of disorders can cause the spleen to enlarge, sometimes to 2kg (roughly 4lbs) or more.
Causes includes:
Infections
Infectious mononucleosis (EBV or CMV), "glandular fever"
Other viral infections
Parasitic infections
Cat scratch disease
Bacterial infections
Liver diseases
Cirrhosis (portal vein obstruction, portal hypertension)
Sclerosing cholangitis
Wilson's disease
Biliary atresia
Cystic fibrosis
Haemolytic anaemias
Thalassemia
Haemoglobinopathies
Haemolytic anaemia due to G6PD deficiency
Idiopathic autoimmune haemolytic anaemia
Immune haemolytic anaemia
Cancers
Leukaemia
Lymphoma
Hodgkin's disease
Sarcoidosis
Sickle cell splenic crisis
Banti's syndrome
Felty syndrome
Hypercalcemia causes:
Most common (malignancy and primary hyperparathyroidism account for 90% of hypercalcemic patients):
Primary hyperparathyroidism
Malignant disease
PTH-related protein (carcinoma of lung, esophagus, head and neck,
renal cell, breast, ovary, and bladder)
Ectopic production of 1,25-dihydroxyvitamin D (lymphoma)
Lytic bone metastases (multiple myeloma, hematologic
malignancies and breast carcinoma)
Other factor(s) produced locally or ectopically
Uncommon:
Endocrine disorders
Thyrotoxicosis
Granulomatous diseases
Sarcoidosis
HIV
Drug-induced
Vitamin D
Thiazide diuretics
Lithium
Estrogens and antiestrogens
Androgens (breast cancer therapy)
Aminophylline
Vitamin A
Aluminum intoxication (in chronic renal failure)
Miscellaneous
Immobilization
Renal failure (acute and chronic)
Total parenteral nutrition
Rare:
Endocrine disorders
Pheochromocytoma
Vasoactive intestinal polypeptide-producing tumor
Familial hypocalciuric hypercalcemia
Granulomatous diseases
Tuberculosis
Histoplasmosis
Coccidioidomycosis
Leprosy
Miscellaneous
Milk-alkali syndrome
Hypophosphatasia
William’s syndrome
Rhabdomyolysis (presentation is usually preceded by a hypocalcemic
state)
Hello~You say his spleen is enlarged? Well the spleen can sometimes cause problems, have you seen an endocrinologist for his problems?