title: Hypercalcemia due to sun exposure in a patient with multiple myeloma and elevated parathyroid hormone-related protein.
abstract: A patient with multiple myeloma who developed hypercalcemia during three different stages of his disease, with a different hypercalcemic agent elevated in his serum on each occasion, is described. The initial episode of hypercalcemia was associated with high serum interleukin-6 (IL-6). After treatment for myeloma normocalcemia was achieved. Subsequently, a relapse of hypercalcemia occurred, this time characterized by frankly elevated plasma parathyroid hormone-related protein (PTHrP) but normal IL-6. Monotherapy with pamidronate infusions resulted in remission of the hypercalcemia and a significant fall in PTHrP levels. A third spell of hypercalcemia characterized by an acute rise in serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D to abnormally high levels occurred during the summer season after prolonged and intense exposure to the sun.
authors.affiliation: Second Division of Endocrinology and Metabolism, Alexandra Hospital, Athens, Greece.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Papapetrou
authors.forename: Marina
authors.initials: M
authors.lastname: Bergi-Stamatelou
authors.forename: Helen
authors.initials: H
authors.lastname: Karga
authors.forename: Stavroula
authors.initials: S
authors.lastname: Thanou
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology*; D007262:Infusions, Intravenous; D008297:Male; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications*; D015675:Osteocalcin / Q000097:blood; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D036361:Peptide Hormones / Q000097:blood*; D012008:Recurrence; D013472:Sunlight / Q000009:adverse effects*; D014807:Vitamin D / Q000097:blood
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004164:Diphosphonates; C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D036361:Peptide Hormones; D015675:Osteocalcin; D014807:Vitamin D; D000469:Alkaline Phosphatase; D000077268:Pamidronate