title: Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature.
abstract: We report a case of a 62-year-old woman with renal cell carcinoma (RCC) presenting with a hypercalcemia-induced coma. A laboratory evaluation indicated nonparathyroid-mediated hypercalcemia with an initial serum calcium level of 18.6 mg/dL. Our patient's parathyroid hormone (PTH)-related peptide level was undetectable. Initial imaging was negative, but PET scan identified a mass in the upper pole of the left kidney. Our patient underwent partial nephrectomy, and the mass was identified as RCC on final pathology. After surgery, her hypercalcemia resolved and PTH returned to normal limits. This case report describes a patient with RCC with the unusual presentation of hypercalcemic coma. We review the differential diagnosis of malignant hypercalcemia and the evaluation of hypercalcemia occurring with RCC. This case illustrates the need to carefully review and interpret all available data, especially when conventional testing in the work-up of hypercalcemia is unrevealing.
authors: Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors: Kara
authors: K
authors: Pepper
authors: Uraporn
authors: U
authors: Jaowattana
authors: Michael D
authors: MD
authors: Starsiak
authors: Raghuueer
authors: R
authors: Halkar
authors: Kelly
authors: K
authors: Hornaman
authors: Wenli
authors: W
authors: Wang
authors: Priya
authors: P
authors: Dayamani
authors: Vin
authors: V
authors: Tangpricha
mesh_terms: D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000175:diagnosis; D003128:Coma / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000150:complications / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D044168:Receptor, Parathyroid Hormone, Type 1 / Q000097:blood
chemical_list: D015850:Interleukin-6; C473449:PTH1R protein, human; D010281:Parathyroid Hormone; D044168:Receptor, Parathyroid Hormone, Type 1