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Takenouchi H, Anno T, Harada A, Isobe H, Kimura Y, Kawasaki F, Kaku K, Tomoda K, Fujiwara H, Kaneto H. Ectopic PTH-producing parathyroid cyst inside the thymus: a case report. BMC Endocr Disord 2022; 22:327. [PMID: 36544116 PMCID: PMC9769032 DOI: 10.1186/s12902-022-01256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The hallmark of hyperparathyroidism is hypersecretion of parathyroid hormone (PTH) which results in hypercalcemia and hypophosphatemia. While hypercalcemia due to malignancy is often brought about by PTH-related protein in adults, PTH-producing tumors are quite rare in clinical practice. Additionally, from the point of embryology, it is very difficult to examine ectopic PTH-producing tissue such as ectopic parathyroid glands. Furthermore, clear histopathological criteria are not present. CASE PRESENTATION A 57-year-old woman was referred to our hospital for hypercalcemia. Her parathyroid hormone (PTH) level was elevated, but there were no enlarged parathyroid glands. Although 99mTc-MIBI confirmed a localized and slightly hyperfunctioning parathyroid tissue in the anterior mediastinum, it was not typical as hyperfunctioning parathyroid. We finally diagnosed her as ectopic PTH-producing cyst-like tumor with venous sampling of PTH. She underwent anterosuperior mediastinal ectopic PTH-producing cyst-like tumor resection. It is noted that intact-PTH concentration of the fluid in the cyst was very high (19,960,000 pg/mL). Based on histopathological findings, we finally diagnosed her as ectopic PTH-producing parathyroid cyst inside the thymus. After resection of anterosuperior mediastinal thymus including ectopic PTH-producing parathyroid cyst, calcium and intact-PTH levels were decreased, and this patient was discharged without any sequelae. CONCLUSIONS We should know the possibility of superior mediastinal ectopic PTH-producing parathyroid cyst inside the thymus among subjects with ectopic PTH-producing parathyroid glands. Particularly when the cyst is present in the superior mediastinum, it is necessary to do careful diagnosis based on not only positive but also negative findings in 99mTc-MIBI. It is noted that the patient's bloody fluid in the cyst contained 19,960,000 pg/mL of intact-PTH, and its overflow into blood stream resulted in hyperparathyroidism and hypercalcemia. Moreover, in such cases, the diagnosis is usually confirmed after through histological examination of ectopic PTH-producing parathyroid glands. We think that it is very meaningful to let clinicians know this case.
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Affiliation(s)
- Haruka Takenouchi
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan.
| | - Ayaka Harada
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Hayato Isobe
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Yukiko Kimura
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Hideyo Fujiwara
- Department of Pathology, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Kurashiki, 701-0192, Japan
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Groysman AY, Poloju A, Majety P, Vyas M, Rosen HN. Bisphosphonate-resistant hypercalcemia in a rare case of paraneoplastic PTH secretion. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.jecr.2022.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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A novel LncRNA PTH-AS upregulates interferon-related DNA damage resistance signature genes and promotes metastasis in human breast cancer xenografts. J Biol Chem 2022; 298:102065. [PMID: 35618021 PMCID: PMC9198338 DOI: 10.1016/j.jbc.2022.102065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) are important tissue-specific regulators of gene expression, and their dysregulation can induce aberrant gene expression leading to various pathological conditions, including cancer. Although many lncRNAs have been discovered by computational analysis, most of these are as yet unannotated. Herein, we describe the nature and function of a novel lncRNA detected downstream of the human parathyroid hormone (PTH) gene in both extremely rare ectopic PTH-producing retroperitoneal malignant fibrous histiocytoma and parathyroid tumors with PTH overproduction. This novel lncRNA, which we have named "PTH-AS," has never been registered in a public database, and here, we investigated for the first time its exact locus, length, transcription direction, polyadenylation, and nuclear localization. Microarray and Gene Ontology analyses demonstrated that forced expression of PTH-AS in PTH-nonexpressing human breast cancer T47D cells did not induce the ectopic expression of the nearby PTH gene but did significantly upregulate Janus kinase-signal transducer and activator of transcription pathway-related genes such as cancer-promoting interferon-related DNA damage resistance signature (IRDS) genes. Importantly, we show that PTH-AS expression not only enhanced T47D cell invasion and resistance to the DNA-damaging drug doxorubicin but also promoted lung metastasis rather than tumor growth in a mouse xenograft model. In addition, PTH-AS-expressing T47D tumors showed increased macrophage infiltration that promoted angiogenesis, similar to IRDS-associated cancer characteristics. Although the detailed molecular mechanism remains imperfectly understood, we conclude that PTH-AS may contribute to tumor development, possibly through IRDS gene upregulation.
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Cetani F, Pardi E, Marcocci C. Parathyroid Carcinoma and Ectopic Secretion of Parathyroid hormone. Endocrinol Metab Clin North Am 2021; 50:683-709. [PMID: 34774241 DOI: 10.1016/j.ecl.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most common causes of hypercalcemia are primary hyperparathyroidism (PHPT) and malignancy. Parathyroid carcinoma (PC), causing a severe PHPT, is the rarest parathyroid tumor. A diagnosis of PC is challenging because the clinical profile overlaps with that of benign counterpart. Surgery is the mainstay treatment. CDC73 mutations have been detected in up to 80% of sporadic PCs. Ectopic production of parathyroid hormone (PTH) by malignant nonparathyroid tumors is a rare condition accounting for less than 1% of hypercalcemia of malignancy. PTH secretion can be considered an aberration in the tissue specificity of gene expression and may involve heterogeneous molecular mechanisms.
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Affiliation(s)
- Filomena Cetani
- University Hospital of Pisa, Endocrine Unit 2, Via Paradisa, 2, Pisa 56124, Italy.
| | - Elena Pardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, Pisa 56124, Italy
| | - Claudio Marcocci
- University Hospital of Pisa, Endocrine Unit 2, Via Paradisa, 2, Pisa 56124, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, Pisa 56124, Italy
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5
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Motlaghzadeh Y, Bilezikian JP, Sellmeyer DE. Rare Causes of Hypercalcemia: 2021 Update. J Clin Endocrinol Metab 2021; 106:3113-3128. [PMID: 34240162 DOI: 10.1210/clinem/dgab504] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism and malignancy are the etiologies in 90% of cases of hypercalcemia. When these entities are not the etiology of hypercalcemia, uncommon conditions need to be considered. In 2005, Jacobs and Bilezikian published a clinical review of rare causes of hypercalcemia, focusing on mechanisms and pathophysiology. This review is an updated synopsis of rare causes of hypercalcemia, extending the observations of the original article. EVIDENCE ACQUISITION Articles reporting rare associations between hypercalcemia and unusual conditions were identified through a comprehensive extensive PubMed-based search using the search terms "hypercalcemia" and "etiology," as well as examining the references in the identified case reports. We categorized the reports by adults vs pediatric and further categorized the adult reports based on etiology. Some included reports lacked definitive assessment of etiology and are reported as unknown mechanism with discussion of likely etiology. EVIDENCE SYNTHESIS There is a growing understanding of the breadth of unusual causes of hypercalcemia. When the cause of hypercalcemia is elusive, a focus on mechanism and review of prior reported cases is key to successful determination of the etiology. CONCLUSIONS The ever-expanding reports of patients with rare and even unknown mechanisms of hypercalcemia illustrate the need for continued investigation into the complexities of human calcium metabolism.
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Affiliation(s)
- Yasaman Motlaghzadeh
- Stanford University School of Medicine, Division of Endocrinology, Gerontology and Metabolism, Palo Alto, CA 94305, USA
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Deborah E Sellmeyer
- Stanford University School of Medicine, Division of Endocrinology, Gerontology and Metabolism, Palo Alto, CA 94305, USA
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O’Callaghan S, Yau H. Treatment of malignancy-associated hypercalcemia with cinacalcet: a paradigm shift. Endocr Connect 2021; 10:R13-R24. [PMID: 33289687 PMCID: PMC7923058 DOI: 10.1530/ec-20-0487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023]
Abstract
Palliation of symptoms related to malignancy-associated hypercalcemia (MAH) is essential and clinically meaningful for patients, given the continued poor prognosis, with high morbidity and mortality associated with this disease process. Historically, agents have been temporizing, having no impact on patient morbidity nor survival. We suggest that cinacalcet can be an efficacious agent to be taken orally, reducing patients' time in the hospital/clinic settings. It is well-tolerated and maintains serum calcium levels in the normal range, while targeted cancer treatments can be employed. This has a direct, major impact on morbidity. Maintaining eucalcemia can increase quality of life, while allowing targeted therapies time to improve survival. Given that our case (and others) showed calcium reduction in MAH, there is promising evidence that cinacalcet can be more widely employed in this setting. Future consideration should be given to studies addressing the efficacy of cinacalcet in calcium normalization, improvement of quality of life, and impact on survival in patients with MAH. Though the exact mechanism of action for cinacalcet's reduction in calcium in this setting is not currently known, we can still afford patients the possible benefit from it.
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Affiliation(s)
- Sondra O’Callaghan
- Endocrinology, Diabetes & Metabolism, Orlando VA Healthcare System, Orlando, Florida, USA
| | - Hanford Yau
- Endocrinology, Diabetes & Metabolism, Orlando VA Healthcare System, Orlando, Florida, USA
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7
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van Lierop AH, Bisschop PH, Boelen A, van Eeden S, Engelman AF, Nieveen van Dijkum EJ, Klümpen HJ. hypercalcaemia due to a calcitriol-producing neuroendocrine tumour. J Surg Case Rep 2019; 2019:rjz346. [PMID: 31832136 PMCID: PMC6900336 DOI: 10.1093/jscr/rjz346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 08/27/2019] [Accepted: 10/27/2019] [Indexed: 11/20/2022] Open
Abstract
In this case report, we describe a 40-year-old patient with a large grade 2 pancreatic neuroendocrine tumour (pNET) with spleen metastasis. Albeit radical resection, he developed liver metastasis after 2 years, for which he underwent radio frequency ablation and embolization, and was treated successfully with different subsequent lines of systemic therapy. Eight years after the initial diagnosis, he was admitted for symptomatic and refractory hypercalcaemia, due to calcitriol synthesis by the liver metastasis. After tumour load reduction by hemihepatectomy, there was an initial normalization of hypercalcaemia, until it recurred after 18 months. In this period, the liver metastasis had progressed despite chemo- and immunotherapy. Patient underwent an additional extend hemihepatectomy, from which he recovered well with normalization of calcium levels. This case illustrates the hormonal plasticity of pNETs and shows how prolonged survival can be achieved for metastatic pNET by multimodality approach.
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Affiliation(s)
- Antoon H van Lierop
- Department of Internal Medicine, Flevoziekenhuis, Almere 1315RA, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105AZ, The Netherlands
| | - Anita Boelen
- Endocrinology Laboratory, Research Institute Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105AZ, The Netherlands
| | - Susanne van Eeden
- Department of Pathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105AZ, The Netherlands
| | - Anton F Engelman
- Deparment of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105AZ, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Elisabeth J Nieveen van Dijkum
- Deparment of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam 1105AZ, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Heinz-Josef Klümpen
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105AZ, The Netherlands
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8
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Disotuar SD, Vázquez RG, Japón MÁ, Cuenca IC, López AP, Moreno AS. Elevated Intact Parathyroid Hormone Produced by a Cervical Neuroendocrine Tumor. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2017-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Uchida K, Tanaka Y, Ichikawa H, Watanabe M, Mitani S, Morita K, Fujii H, Ishikawa M, Yoshino G, Okinaga H, Nagae G, Aburatani H, Ikeda Y, Susa T, Tamamori-Adachi M, Fukusato T, Uozaki H, Okazaki T, Iizuka M. An Excess of CYP24A1, Lack of CaSR, and a Novel lncRNA Near the PTH Gene Characterize an Ectopic PTH-Producing Tumor. J Endocr Soc 2017; 1:691-711. [PMID: 29264523 PMCID: PMC5686629 DOI: 10.1210/js.2017-00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
Thus far, only 23 cases of the ectopic production of parathyroid hormone (PTH) have been reported. We have characterized the genome-wide transcription profile of an ectopic PTH-producing tumor originating from a retroperitoneal histiocytoma. We found that the calcium-sensing receptor (CaSR) was barely expressed in the tumor. Lack of CaSR, a crucial braking apparatus in the presence of both intraparathyroid and, probably, serendipitous PTH expression, might contribute strongly to the establishment and maintenance of the ectopic transcriptional activation of the PTH gene in nonparathyroid cells. Along with candidate drivers with a crucial frameshift mutation or copy number variation at specific chromosomal areas obtained from whole exome sequencing, we identified robust tumor-specific cytochrome P450 family 24 subfamily A member 1 (CYP24A1) overproduction, which was not observed in other non–PTH-expressing retroperitoneal histiocytoma and parathyroid adenoma samples. We then found a 2.5-kb noncoding RNA in the PTH 3′-downstream region that was exclusively present in the parathyroid adenoma and our tumor. Such a co-occurrence might act as another driver of ectopic PTH-producing tumorigenesis; both might release the control of PTH gene expression by shutting down the other branches of the safety system (e.g., CaSR and the vitamin D3–vitamin D receptor axis).
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Affiliation(s)
- Kosuke Uchida
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan.,Department of General Practice, National Defense Medical College, Saitama 359-0042, Japan
| | - Yuji Tanaka
- Department of General Practice, National Defense Medical College, Saitama 359-0042, Japan
| | - Hitoshi Ichikawa
- Genetics Division, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Masato Watanabe
- Department of Pathology, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Sachiyo Mitani
- Genetics Division, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Koji Morita
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Hiroko Fujii
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan.,Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo 154-8532, Japan
| | - Mayumi Ishikawa
- Diabetes and Arteriosclerosis, Nippon Medical School, Musashikosugi Hospital, Kanagawa 211-8533, Japan
| | - Gen Yoshino
- Center for Diabetes, Shinsuma General Hospital, Hyogo 654-0047, Japan
| | - Hiroko Okinaga
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Genta Nagae
- Genome Science Laboratory Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan
| | - Hiroyuki Aburatani
- Genome Science Laboratory Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo 153-8904, Japan
| | - Yoshifumi Ikeda
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Takao Susa
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Mimi Tamamori-Adachi
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Toshio Fukusato
- Department of Pathology, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Hiroshi Uozaki
- Department of Pathology, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Tomoki Okazaki
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan
| | - Masayoshi Iizuka
- Department of Biochemistry, Teikyo University School of Medicine, Tokyo 173-0003, Japan
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10
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Hypercalcemia of Malignancy in Thymic Carcinoma: Evolving Mechanisms of Hypercalcemia and Targeted Therapies. Case Rep Endocrinol 2017; 2017:2608392. [PMID: 28168064 PMCID: PMC5266834 DOI: 10.1155/2017/2608392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Here we describe, to our knowledge, the first case where an evolution of mechanisms responsible for hypercalcemia occurred in undifferentiated thymic carcinoma and discuss specific management strategies for hypercalcemia of malignancy (HCM). Case Description. We report a 26-year-old male with newly diagnosed undifferentiated thymic carcinoma associated with HCM. Osteolytic metastasis-related hypercalcemia was presumed to be the etiology of hypercalcemia that responded to intravenous hydration and bisphosphonate therapy. Subsequently, refractory hypercalcemia persisted despite the administration of bisphosphonates and denosumab indicative of refractory hypercalcemia. Elevated 1,25-dihydroxyvitamin D was noted from the second admission with hypercalcemia responding to glucocorticoid administration. A subsequent PTHrP was also elevated, further supporting multiple mechanistic evolution of HCM. The different mechanisms of HCM are summarized with the role of tailoring therapies based on the particular mechanism underlying hypercalcemia discussed. Conclusion. Our case illustrates the importance of a comprehensive initial evaluation and reevaluation of all identifiable mechanisms of HCM, especially in the setting of recurrent and refractory hypercalcemia. Knowledge of the known and possible evolution of the underlying mechanisms for HCM is important for application of specific therapies that target those mechanisms. Specific targeting therapies to the underlying mechanisms for HCM could positively affect patient outcomes.
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Abstract
Hypercalcemia of malignancy affects up to one in five cancer patients during the course of their disease. It is associated with both liquid malignancies, commonly multiple myeloma, leukemia, and non-Hodgkins lymphoma and solid cancers, particularly breast and renal carcinomas as well as squamous cell carcinomas of any organ. The clinical manifestations of hypercalcemia are generally constitutional in nature and not specific to the inciting malignancy. Such physical manifestations can range from malaise to lethargy and confusion. Constipation and anorexia are common. Acute kidney injury is likely the most frequently encountered manifestation of end organ damage. Symptomatology is closely linked to both the absolute elevation of serum calcium levels and the rapidity of calcium rise. The majority of cases are humoral in etiology and related to parathyroid hormone-related protein (PTHrP). Approximately 20% of cases are the result of direct bone metastasis with extra-renal 1,25-dihydroxyvitamin D (calcitriol) and ectopic parathyroid hormone production likely accounting for less than 1% of cases. The diagnosis of hypercalcemia of malignancy is confirmed either by an elevated PTHrP or by an evidence of bone metastasis in the appropriate clinical setting. Treatment is predicated on the patient’s symptoms and absolute serum calcium level. Interventions are aimed at lowering the serum calcium concentration by inhibiting bone resorption and increasing urinary calcium excretion, the former accomplished via bisphosphonate therapy and the latter with aggressive hydration. Novel therapies for refractory disease include denosumab, a monoclonal antibody against the receptor activator of nuclear factor κB ligand, and the calcimimetic cinacalcet. Finally, anti-PTHrP antibodies have been successfully deployed in animal models of disease. Despite the efficacy of the above therapies, hypercalcemia of malignancy portends an ominous prognosis, indicating advanced and often refractory cancer with survival on the order of months.
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Affiliation(s)
- Hillel Sternlicht
- Division of Nephrology and Hypertension, Weill Cornell Medical College
| | - Ilya G Glezerman
- Division of Nephrology and Hypertension, Weill Cornell Medical College ; Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Objective To report the case of a 28-year-old woman who presented with hypercalcemia (total calcium =4.11 mmol/L), elevated parathyroid hormone (PTH) 24.6 pmol/L, normal parathyroid hormone-related peptide 7.8 pg/mL, and a 63 mm × 57 mm, poorly differentiated neuroendocrine carcinoma (small-cell type) pancreatic mass with liver metastases. Investigations and treatment Hypercalcemia was acutely managed with intravenous fluids, pamidronate and calcitonin. Investigations for multiple endocrine neoplasia type 1 and parathyroid adenoma were initiated. The identified neuroendocrine tumor was treated with cisplatinum/etoposide chemotherapy. Results The pancreatic mass (56 mm × 49 mm) and metastases decreased in size with chemotherapy and calcium levels normalized. Eight months later, calcium increased to 3.23 mmol/L, PTH increased to 48.2 pmol/L, and the pancreatic mass increased in size to 67 mm × 58 mm. The patient was given a trial of cinacalcet but was unable to tolerate it. Chemotherapy was restarted and resulted in a decrease in the pancreatic mass (49 mm × 42 mm), a reduction in PTH levels (16.6 pmol/L), and calcium levels (2.34 mmol/L). Conclusion Ectopic PTH secreting tumors should be considered when there is no parathyroid related cause for an elevated PTH. Recognizing the association between PTH and hypercalcemia of malignancy may lead to an earlier detection of an undiagnosed malignancy.
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Affiliation(s)
- Mary-Anne Doyle
- Division of Endocrinology, University of Ottawa, Ottawa, ON, Canada
| | - Janine C Malcolm
- Division of Endocrinology, University of Ottawa, Ottawa, ON, Canada
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Kharb S, Pandit A, Gundgurthi A, Garg MK, Brar KS, Kannan N, Bharwaj R. Hidden diagnosis of multiple endocrine neoplasia-1 unraveled during workup of virilization caused by adrenocortical carcinoma. Indian J Endocrinol Metab 2013; 17:514-518. [PMID: 23869313 PMCID: PMC3712387 DOI: 10.4103/2230-8210.111672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Multiple endocrine neoplasia-1 (MEN1) is an autosomal dominant syndrome with classic triad of parathyroid hyperplasia, pancreatic neuroendocrine tumors, and pituitary adenomas. Other recognized manifestations include carcinoid, cutaneous or adrenocortical tumors. It is commonly presented with clinical features related to parathyroid, pancreas or pituitary lesions. Here, we have presented a case that had virilization and biochemical Cushing's syndrome due to adrenocortical carcinoma as presenting feature of MEN1. Cushing's syndrome in MEN1 is an extremely rare and usually late manifestation and most cases are due to corticotropin-producing pituitary adenomas. Although Cushing's syndrome generally develops years after the more typical manifestations of MEN1 appear, it may be the primary manifestation of MEN1 syndrome particularly when related to adrenal adenoma or carcinoma.
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Affiliation(s)
- Sandeep Kharb
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - Aditi Pandit
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - Abhay Gundgurthi
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - M. K. Garg
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - K. S. Brar
- Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India
| | - N. Kannan
- Department of Oncoosurgery, Army Hospital (Research and Referral), Delhi Cantt, India
| | - Reena Bharwaj
- Department of Pathology, Army Hospital (Research and Referral), Delhi Cantt, India
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Ro C, Chai W, Yu VE, Yu R. Pancreatic neuroendocrine tumors: biology, diagnosis,and treatment. CHINESE JOURNAL OF CANCER 2012; 32:312-24. [PMID: 23237225 PMCID: PMC3845620 DOI: 10.5732/cjc.012.10295] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreatic neuroendocrine tumors (PNETs), a group of endocrine tumors arising in the pancreas, are among the most common neuroendocrine tumors. The genetic causes of familial and sporadic PNETs are somewhat understood, but their molecular pathogenesis remains unknown. Most PNETs are indolent but have malignant potential. The biological behavior of an individual PNET is unpredictable; higher tumor grade, lymph node and liver metastasis, and larger tumor size generally indicate a less favorable prognosis. Endocrine testing, imaging, and histological evidence are necessary to accurately diagnose PNETs. A 4-pronged aggressive treatment approach consisting of surgery, locoregional therapy, systemic therapy, and complication control has become popular in academic centers around the world. The optimal application of the multiple systemic therapeutic modalities is under development; efficacy, safety, availability, and cost should be considered when treating a specific patient. The clinical presentation, diagnosis, and treatment of specific types of PNETs and familial PNET syndromes, including the novel Mahvash disease, are summarized.
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Affiliation(s)
- Cynthia Ro
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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