Tetany due to Hypomagnesemia Induced by Cisplatin and Doxorubicin Treatment for Synovial Sarcoma

• Published in: Internal Medicine Vol. 32; no. 5; pp. 434 - 437
• Main Authors: MUNE, Tomoatsu, YASUDA, Keigo, ISHII, Mitsukazu, MATSUNAGA, Takanobu, MIURA, Kiyoshi
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 1993; Japanese Society of Internal Medicine
• Subjects: Adolescent; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Bone Neoplasms - blood; Bone Neoplasms - drug therapy; Bone Neoplasms - surgery; Cisplatin - adverse effects; Doxorubicin - adverse effects; Drug toxicity and drugs side effects treatment; functional hypoparathyroidism; Humans; hypocalcemia; Hypocalcemia - chemically induced; Hypoparathyroidism - complications; Magnesium - blood; Magnesium - therapeutic use; Male; Medical sciences; parathyroid hormone; parathyroid hormone-related protein; Pharmacology. Drug treatments; Sarcoma, Synovial - blood; Sarcoma, Synovial - drug therapy; Sarcoma, Synovial - surgery; Tetany - drug therapy; Tetany - etiology; Toxicity: nervous system and muscle; Case study; Human; Toxicity; Tetany; Diseases of the osteoarticular system; Lower limb; Malignant tumor; Malignant synovioma; Hypocalcemia; Hypomagnesemia
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.32.434

Hypocalcemi ccrisis developed in a patient with monophasic synovial sarcoma after amputation of the right leg, followed by long-term treatment with cisplatin and doxorubicin. Laboratory data revealed severe hypomagnesemia and hypocalcemia. High normal intact parathyroid hormone (PTH), elevated mid-region PTH and undetectable osteocalcin levels had already been found before the appearance of obvious symptomsconcomitantly associated with moderate hypomagnesemia and hypocalcemia. Further, both PTH levels measured by two different methods gradually decreased until the initiation of magnesium supplementation. The magnesium supplement immediately relieved the tetany, and induced striking increases in both intact and mid-region PTH levels transiently and continuous elevations of osteocalcin levels. These results suggest that magnesiumdepletion has dual effects on PTHsecretion, from stimulation to inhibition, as hypomagnesemia progresses. Both relative hypoparathyroidism and refractoriness of bone to PTH were thought to be responsible for hypocalcemia due to hypomagnesemia. (Internal Medicine 32: 434-437, 1993)