TY - JOUR
AU - Murray, David, L
AB - The authors present an illustrative case of multiple myeloma (MM) that presented as symptomatic hypercalcemia. Although hypercalcemia is part of the “CRAB” diagnostic criteria (increased calcium level, renal dysfunction, anemia, and destructive bone lesions), symptomatic hypercalcemia is not a common presentation of MM. In a study of patients presenting with MM, anemia was present initially in 73% of patients, hypercalcemia (total calcium ≥11 mg/dL) in 13%, and a serum creatinine concentration ≥2 mg/dL in 19% (1). In addition, most cases of hypercalcemia were not symptomatic but documented only on clinical suspicion of MM. Hence, it may be easy for clinicians to not associate symptomatic hypercalcemia with MM. The coexistent hyperviscosity syndrome, also a less common finding, most likely exacerbated the patient's symptoms. There are several clues presented in this case that should trigger suspicion of malignancy: the history of weight loss, symptomatic anemia, and the increased κ free light chains >100 mg/dL. As the authors point out, a decreased anion gap can also be a good clue for the presence of high concentration M protein. There are only a few causes for a decreased anion gap, with the 2 most common causes being hypoalbuminemia and high immunoglobulin concentrations. In a patient with increased total proteins, a decreased anion gap is a good indicator of an underlying plasma cell disorder. Lastly, this case highlights that MM typically presents without a prior diagnosis of monoclonal gammopathy of undermined significance when multiple studies have shown that multiple myeloma is consistently preceded by it (2). Author Contributions:All authors confirmed they have contributed to the intellectual content of this paper and have met the following 4 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects of the article thus ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved. Authors' Disclosures or Potential Conflicts of Interest:Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest: Employment or Leadership: None declared. Consultant or Advisory Role: D.L. Murray, The Binding Site. Stock Ownership: None declared. Honoraria: None declared. Research Funding: None declared. Expert Testimony: None declared. Patents: None declared. References 1. Landgren O , Kyle RA, Rajkumar SV. From myeloma precursor disease to multiple myeloma: new diagnostic concepts and opportunities for early intervention . Clin Cancer Res 2011 ; 17 : 1243 – 52 . Google Scholar Crossref Search ADS PubMed WorldCat 2. Landgren O , Kyle RA, Pfeiffer RM, Katzmann JA, Caporaso NE, Hayes RB. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study . Blood 2009 ; 113 : 5412 – 7 . Google Scholar Crossref Search ADS PubMed WorldCat © 2019 The American Association for Clinical Chemistry This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Commentary
JF - Clinical Chemistry
DO - 10.1373/clinchem.2019.302901
DA - 2019-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/commentary-wzOtTuPHdf
SP - 837
VL - 65
IS - 7
DP - DeepDyve
ER -