In this case of a 63-year-old man the essential complaint during the first three months of illness was muscular weakness, affecting especially the legs and progressing to complete disability. Later symptoms led to surgical removal of the right kidney and diagnosis of clear-cell carcinoma. The nephrectomy was followed by improvement in neuromuscular status until muscle strength had returned to almost normal. Deep reflexes in the legs did not return, and biopsy of the quadriceps femoris muscle revealed extensive atrophy. Hypercalcemia was detected before operation and subsided thereafter; its time-relation to other blood-chemical findings, to the neuromuscular disturbance, to osteoblastic activity manifested in the bones, and to the ultimate appearance of masses in both lungs suggests that calcium played a central role in the symptomatology of this patient.
Alanis BF, Flanagan JF. MYOPATHY AND HYPERCALCEMIA OCCURRING WITH CARCINOMA OF THE KIDNEY. JAMA. 1959;171(15):2076–2080. doi:https://doi.org/10.1001/jama.1959.03010330038010
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