Persistent and moderate hypercalcemia related to an ovarian clear cell adenocarcinoma: Pre- and postoperative parathyroid hormone related-peptide and 1,25-dihydroxyvitamin D3 levels.
OBJECTIVE
To evaluate the role of PTH-related peptide (PTH-rP) and 1,25-dihyhydroxyvitamin D3 in a case of hypercalcemia related to an ovarian adenocarcinoma.


METHODS
We report a case of humoral hypercalcemia in a patient aged 74 yr with a clear cell adenocarcinoma of the right ovary at an early stage of its development (stage T1aN0M0) revealed by moderate and persistent hypercalcemia (variable level between 2.7 and 3.2 mmol/l without any treatment) over six months.


METHODS
PTH-rP and 1,25-dihydroxyvitamin D3 were measured in blood samples taken before and after hysterectomy and bilateral salpingooophorectomy and in blood samples taken intraoperatively from the right ovarian vein and a peripheral vein.


RESULTS
High levels of plasma PTH-rP and 1,25-dihydroxyvitamin D3 concomitant with high serum calcium and low PTH levels were found before surgery, which was followed by normalisation of all parameters studied. A concentration gradient was found regarding plasma PTHrP (right ovarian vein 60.4 pmol/l, peripheral vein 4.5 pmol/l), not 1,25-dihydroxyvitamin D3.


CONCLUSIONS
1) moderate and persistent hypercalcemia can be observed at an early stage of an ovarian carcinoma; 2) the gradient of PTH-rP concentration between the samples taken from the right ovarian vein and a peripheral vein provides evidence for a direct secretion of PTH-rP by the ovarian tumor; 3) the increased 1,25-dihydroxyvitamin D3 level is not related to a direct ovarian production, but is a consequence of PTH-rP secretion.
Benit
A
A
Service d'Endocrinologie, Hôpital Rangueil, CHU Toulouse, France.
Allard
J
J
Rimailho
J
J
Fauvel
J
J
Escourrou
G
G
Vezzosi
D
D
Donadille
F
F
Bennet
A
A
Caron
P
P
D018262:Adenocarcinoma, Clear Cell / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D000368:Aged; D002117:Calcitriol / Q000097:blood*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D007432:Intraoperative Period; D010051:Ovarian Neoplasms / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D044162:Parathyroid Hormone-Related Protein / Q000097:blood*; D011184:Postoperative Period; D011300:Preoperative Care
D044162:Parathyroid Hormone-Related Protein; D002117:Calcitriol