- Even in the absence of the IgG chains in the urine, there are certain red flags that suggest a sinister cause for the back pain, e.g. weight loss and elevated ESR
- More than 1 g light chains excreted in the urine per day is a major criterion for the diagnosis of myeloma
- Bisphosphonates may be used to treat hypercalcaemia associated with myeloma
- Radiotherapy can be used to relieve bone pain
Sarcoidosis
- Dry cough, shortness of breath, bilateral hilar lymphadenopathy
- Abnormal incidental chest radiograph finding or respiratory symptoms are the initial presentations in up to 50% of sarcoid patients
- TB, malignancy, silicosis and extrinsic allergic alveolitis are other causes of bilateral hilar lymphadenopathy
- There is a higher incidence of sarcoidosis among African-Carribeans
Bone metastases
- Non-steroidal anti-inflammatory drugs [NSAIDs] such as ibuprofen are a particularly good first-line drug for the treatment of bone pain associated with metastases
PTH-like hormone secretion
- Ectopic parathyroid hormone (PTH)-related protein secretion by squamous cell carcinoma is a relatively rare cause of hypercalcaemia
Tertiary hyperparathyroidism
- Tertiary hyperparathyroidism involves the development of autonomous parathyroid hyperplasia that occurs after long-standing secondary hyper-parathyroidism
- Both plasma calcium and phosphate are raised
- Secondary hyperparathyroidism is physiological hypertrophy of the parathyroid glands in response to hypocalcaemia
- In this way, plasma calcium is usually low or normal in secondary hyperparathyroidism
- Vitamin D deficiency and chronic renal failure are well-recognised causes of secondary hyperparathyroidism
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