Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- jugular venous distention
- lower extremity oedema
- periorbital purpura
- macroglossia
Other diagnostic factors
- fatigue
- weight loss
- dyspnoea on exertion
- paraesthesia
- claudication
- nausea
- abdominal cramps
- alternating bowel habit
- light-headed/orthostatic hypotension
- submandibular salivary gland enlargement
- hepatomegaly
- shoulder pad sign
- diffuse muscular weakness
- sensory neuropathy
- Tinel's sign
- Phalen's manoeuvre
Risk factors
- monoclonal gammopathy of undetermined significance (MGUS)
- inflammatory polyarthropathy
- chronic infections
- inflammatory bowel disease
- Castleman's disease
- familial periodic fever syndromes
Diagnostic investigations
1st investigations to order
- serum immunofixation
- urine immunofixation
- immunoglobulin free light chain assay
- bone marrow biopsy
Investigations to consider
- tissue biopsy
- immunohistological studies of amyloid deposits
- mass spectroscopy
- immuno-electron microscopy
- genetic testing
- serum amyloid P (SAP) scintigraphy scan
- FBC
- comprehensive metabolic profile
- 24-hour urine collection
- serum troponin level
- B-type natriuretic peptide
- beta-2-microglobulin
- ECG
- echocardiogram
- Doppler echo with strain
- cardiac MRI
Treatment algorithm
Contributors
Authors VIEW ALL
Seidler Jr. Professor of Medicine
Consultant in Hematology
Chair of the Department of Medicine
Mayo Distinguished Clinician
Mayo Clinic College of Medicine
Rochester
MN
Disclosures
MAG declares that he has received honoraria from Celgene Corporation, Prothena Corporation Plc, Onyx Pharmaceuticals, and Ionis Pharmaceuticals. MAG is also an author of several references cited in this monograph.
Peer reviewers VIEW ALL
Associate Professor of Medicine
Director
Program for Multiple Myeloma and Related Diseases
Princess Margaret Hospital
Toronto
Ontario
Canada
Disclosures
DR has been reimbursed by Millennium Pharmaceuticals, Inc and Johnson and Johnson, the manufacturers of bortezomib, for attending several conferences, for speaking at educational meetings, and for consulting work. She has also been reimbursed by Celgene, the manufacturer of lenalidomide and thalidomide, for attending several symposia and serving as a speaker.
Assistant Professor of Medicine and Oncology
Division of Hematology/Oncology
Wayne State University School of Medicine
Barbara Ann Karmanos Cancer Institute
Detroit
MI
Disclosures
JZ declares that he has no competing interests.
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