title: Hypercalcaemia in relapsed medulloblastoma 8 years post-diagnosis; evidence to support PTHrP production by medulloblastoma cells.
abstract: BACKGROUND
  A 19-year-old male presented with symptomatic hypercalcaemia as the first manifestation of relapsed metastatic medulloblastoma. Management at the time of the initial presentation 8 years earlier was with surgical excision and craniospinal radiotherapy. His biochemistry at the time of relapse and studies of medulloblastoma cell lines provide an insight into the pathogenesis of his hypercalcaemia.
  
  
  METHODS
  Parathyroid hormone-related protein (PTHrP) was measured by immunoradiometric assay in blood, and in conditioned and control media from three medulloblastoma cell lines following 72 h growth.
  
  
  RESULTS
  The histology at initial presentation (11 years of age) and at the time of relapse (with bone marrow infiltration and widespread bony metastases) demonstrated medulloblastoma. Ionised calcium concentrations at relapse were 2.89 mmol/l and serum PTHrP levels were increased at the same time (2.7 pmol/l; normal range: 0.7-1.8 pmol/l). There was evidence of PTHrP production by one cell line (MHH-MED-8A) while results for both other lines tested were below the limit of detection.
  
  
  CONCLUSIONS
  Relapse 8 years after diagnosis is unusual in medulloblastoma and for this relapse to manifest as hypercalcaemia is also very uncommon. Our investigations suggest that the clinical picture was a reflection of PTHrP production by medulloblastoma cells.
authors.affiliation: Department of Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: P
authors.initials: P
authors.lastname: Dharmaraj
authors.forename: S
authors.initials: S
authors.lastname: Ball
authors.forename: H
authors.initials: H
authors.lastname: Johnstone
authors.forename: S
authors.initials: S
authors.lastname: Bailey
authors.forename: S C
authors.initials: SC
authors.lastname: Clifford
authors.forename: J
authors.initials: J
authors.lastname: Hale
authors.forename: T D
authors.initials: TD
authors.lastname: Cheetham
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000556:secondary*; D002528:Cerebellar Neoplasms / Q000150:complications* / Q000473:pathology; D002648:Child; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008297:Male; D008527:Medulloblastoma / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D044162:Parathyroid Hormone-Related Protein / Q000096:biosynthesis*; D012008:Recurrence
chemical_list: D044162:Parathyroid Hormone-Related Protein