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Karki S, Galiveeti S, Leung V. Hypercalcemia and Renal Mass: A Diagnostically Challenging Case. Cureus 2021; 13:e16718. [PMID: 34513354 PMCID: PMC8405178 DOI: 10.7759/cureus.16718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
Hypercalcemia of malignancy frequently occurs in patients with solid tumors as a paraneoplastic syndrome known as humoral hypercalcemia of malignancy (HHM), caused by the secretion of parathyroid hormone-related peptide (PTHrP). On the other hand, 1,25-dihydroxyvitamin D [1,25(OH)2D]-mediated hypercalcemia is a less common cause of hypercalcemia of malignancy and is mostly observed in lymphoma patients. Here, we report an interesting case of a 77-year-old male nursing home resident with suspected renal cell carcinoma (RCC) presenting with severe hypercalcemia (18.7 mg/dL), which was initially presumed to be HHM. However, workup revealed nonsuppressed parathyroid hormone, low PTHrP, and elevated 25-hydroxyvitamin D and 1,25(OH)2D levels. Steroids were initiated due to an inadequate response to bisphosphonate therapy and elevated vitamin D metabolites, resulting in further reduction in serum calcium levels. This case highlights the need to consider multiple concurrent etiologies in the differential diagnosis of severe hypercalcemia, including the possible role of calcitriol-mediated hypercalcemia in RCC.
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Affiliation(s)
- Sunita Karki
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Sneha Galiveeti
- Endocrinology, Diabetes and Metabolism, BronxCare Health System, Bronx, USA
| | - Vivien Leung
- Endocrinology, Diabetes and Metabolism, BronxCare Health System, Bronx, USA
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Jandou I, Wichou E, Ettanji A, Moataz A, Mohammed D, Debbagh A, Aboutaieb R. Hypercalcemia an exceptional complication in upper urinary tract urothelial carcinoma. J Surg Case Rep 2021; 2021:rjaa574. [PMID: 33604018 PMCID: PMC7880700 DOI: 10.1093/jscr/rjaa574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
Tumors of the upper urinary tract are discovered, either by clinical symptomatology or as part of the evaluation of a bladder tumor. Hypercalcemia is one of the most common paraneoplastic syndromes and an exceptional complication of urothelial carcinoma of the upper tract. Several physiopathological mechanisms have been proposed to explain this rare and serious complication. Hypercalcemia is often correlated with tumors with a poor prognosis.
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Affiliation(s)
- Issam Jandou
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Elmehdi Wichou
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Adnane Ettanji
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Amine Moataz
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Dakir Mohammed
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Adil Debbagh
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
| | - Rachid Aboutaieb
- University Hospital Center Ibn Rochd Casablanca, Casablanca, Morroco
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Hayashida M, Yano A, Hagiwara K, Nagamoto S, Ogawa K, Sakaguchi K, Sawa N, Okaneya T, Urakami S. Relevance of concurrent hypercalcemia in ureteric sarcoidosis complicated with bladder urothelial carcinoma: a case report. BMC Nephrol 2020; 21:235. [PMID: 32571234 PMCID: PMC7310021 DOI: 10.1186/s12882-020-01893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sarcoidosis is a multisystem inflammatory disorder and can affect any organ; however, ureteric involvement is extremely rare with only four cases reported in the literature to date, all of which were diagnosed with surgical ureteral resection including a nephroureterectomy. This study reports the first case of ureteric sarcoidosis controlled with medical therapy where a differential diagnosis was performed based on the diagnostic clue of hypercalcemia. A definitive diagnosis was established without surgical resection of the ureter. CASE PRESENTATION A 60-year-old man presented with anorexia and weight loss. Blood tests showed renal dysfunction and hypercalcemia. Computed tomography revealed left hydronephrosis associated with left lower ureteral wall thickening, which showed high signal intensity on diffusion-weighted magnetic resonance imaging. Similarly, we detected a bladder tumor on cystoscopy, and a 2-cm-long stenosis was revealed by retrograde ureterography; therefore, ureteral cancer was suspected. Meanwhile, considering the clinical implication of hypercalcemia, a differential diagnosis of sarcoidosis was established based on elevated levels of sarcoidosis markers. Fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the left lower ureter, skin, and muscles, suggestive of ureteric sarcoidosis with systemic sarcoid nodules. For a definitive diagnosis, transurethral resection of the bladder tumor and ureteroscopic biopsy were performed. Histopathological examination revealed ureteric sarcoidosis with bladder urothelial carcinoma. Following an oral administration of prednisolone, hypercalcemia instantly resolved, the renal function immediately improved, and the left ureteral lesion showed complete resolution with no recurrence. CONCLUSIONS In this case, the co-occurrence of ureteral lesion with bladder tumor evoked a diagnosis of ureteral cancer. However, considering a case of ureteral lesion complicated with hypercalcemia, assessment for differential diagnosis was performed based on the calcium metabolism and sarcoidosis markers. In cases of suspected ureteric sarcoidosis from the assessment, pathological evaluation with ureteroscopic biopsy should be performed to avoid nephroureterectomy.
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Affiliation(s)
- Michikata Hayashida
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Akihiro Yano
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
| | - Kiichi Hagiwara
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Shoichi Nagamoto
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Kohei Ogawa
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Kazushige Sakaguchi
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo, Japan
| | - Toshikazu Okaneya
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Shinji Urakami
- Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
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Charoenngam N, Hossein-Nezhad A, Hanley DA, Holick MF. Misconception about the cause of vitamin D toxicity. CMAJ 2019; 191:E769. [PMID: 31285383 DOI: 10.1503/cmaj.72511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nipith Charoenngam
- Postdoctoral research fellow, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Arash Hossein-Nezhad
- Research assistant professor, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - David A Hanley
- Professor emeritus, Departments of Medicine, Community Health Sciences, and Oncology, Cumming School of Medicine, The University of Calgary, Calgary, Alta
| | - Michael F Holick
- Professor, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Mass
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Vogeser M, Bidlingmaier M, Wallaschowski H, Lindner J, Kratzsch J. Quantification of 1,25-dihydroxyvitamin D – value of manufacturers’ product information. Clin Chem Lab Med 2018; 56:e46-e49. [DOI: 10.1515/cclm-2017-0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Vogeser
- Institute of Laboratory Medicine , University Hospital, LMU Munich , Marchioninistr. 15 , 81377 Munich , Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV , University Hospital, LMU Munich , Munich , Germany
| | - Henri Wallaschowski
- Institute of Clinical Chemistry and Laboratory Medicine , University Greifswald , Greifswald , Germany
| | - Johanna Lindner
- Institute of Laboratory Medicine , University Hospital, LMU Munich , Munich , Germany
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine , University of Leipzig , Leipzig , Germany
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