title: Concurrent primary hyperparathyroidism and humoral hypercalcemia of malignancy in a patient with multiple endocrine neoplasia type 1.
abstract: We report a patient with multiple endocrine neoplasia type 1 presenting with elevation of parathyroid hormone-related protein (PTHrP) from a metastatic pancreatic neuroendocrine tumor (PNET), and parathyroid hormone (PTH) from primary hyperparathyroidism, resulting in severe hypercalcemia. Parathyroid hormone-related protein production by the PNET was confirmed by immunohistochemical analysis. Hypercalcemia and elevated PTHrP improved markedly with hepatic artery chemoembolization of liver metastasis. Thus, in multiple endocrine neoplasia type 1, correct identification of the cause of hypercalcemia as PTHrP production from a PNET or PTH production from a parathyroid tumor has important therapeutic implications.
authors.affiliation: Division of Endocrinology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Milanesi
authors.forename: Run
authors.initials: R
authors.lastname: Yu
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Geller
authors.forename: Doug
authors.initials: D
authors.lastname: Burton
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Deftos
authors.forename: Edward M
authors.initials: EM
authors.lastname: Wolin
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D006934:Hypercalcemia / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D018358:Neuroendocrine Tumors / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D044162:Parathyroid Hormone-Related Protein / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000378:metabolism
chemical_list: D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein