title: Hypercalcemia in upper urinary tract urothelial carcinoma: a case report and literature review.
abstract: Objective. We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D. Methods. We present a clinical case and a summary of literature search. Results. A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0 mg/mL He also had five small right lung nodules with a negative bone scan. Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL. The patient's calcium was normalized after hydration, and he underwent radical nephrectomy. On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1 mg/dL. Pathology showed a 6 cm high-grade urothelial carcinoma with divergent differentiation. We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English. No cases have a documented elevated 1,25-dihydroxyvitamin D level. Conclusion. This clinical course suggests that hypercalcemia in this case is from the patient's tumor, which was likely producing 1,25-dihydroxyvitamin D. Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D.
authors.affiliation: Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, The University of Michigan, Brehm Tower Room 5107, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105-1912, USA.
authors.forename: Keiko
authors.initials: K
authors.lastname: Asao
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: McHugh
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Nazanene H
authors.initials: NH
authors.lastname: Esfandiari