Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature.
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.
Pepper
Kara
K
Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Jaowattana
Uraporn
U
Starsiak
Michael D
MD
Halkar
Raghuueer
R
Hornaman
Kelly
K
Wang
Wenli
W
Dayamani
Priya
P
Tangpricha
Vin
V
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
D015850:Interleukin-6; C473449:PTH1R protein, human; D010281:Parathyroid Hormone; D044168:Receptor, Parathyroid Hormone, Type 1