title: All-Trans-Retinoic-Acid Unmasking Hypercalcemia of Hyperparathyroidism.
abstract: We present a patient of acute promyelocytic leukaemia managed with all-trans-retinoic-acid and arsenic trioxide who developed hypercalcemia with target organ damage. The patient also was simultaneously discovered to be symptomatic from hyperparathyroidism, which was unmasked after ATRA administration. Patient was successfully managed without any interruption of ATRA therapy and parathyroidectomy. We discuss the mechanisms of ATRA in causing hypercalcemia and its possible role in index case in unmasking hyperparathyroidism. Present case refutes Occam's razor and emphasise that known adverse effects shouldn't withhold clinicians from working up for other common causes for a given condition.
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Uday
authors.initials: U
authors.lastname: Yanamandra
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Kamal Kant
authors.initials: KK
authors.lastname: Sahu
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Alka
authors.initials: A
authors.lastname: Khadwal
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Subhash Chander
authors.initials: SC
authors.lastname: Varma
authors.affiliation: Department of Clinical Haematology, Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra