Malignant hypercalcaemia related to parathyroid hormone-related peptide (PTHrP) secretion from a metastatic pancreatic neuroendocrine tumour (NET).
A 54-year-old woman presented to our centre with acute abdominal pain and vomiting. Routine blood tests showed severe hypercalcaemia (>4 mmol/L). Serum parathyroid hormone (PTH) was suppressed. CT scan detected a pancreatic mass and some liver lesions, initially suspicious for metastatic pancreatic adenocarcinoma. Liver biopsy however revealed the presence of a well-differentiated, grade 1, metastatic neuroendocrine tumour (NET) where prognosis is considerably better. Serum PTHrP was raised, indicating paraneoplastic hypercalcaemia, most likely secondary to the pancreatic NET. Following injection of a short-acting somatostatin analogue octreotide, serum PTHrP levels normalised within 24 hours, causing a rapid drop of serum calcium below the lower limit of normal and an immediate compensatory rise of serum PTH. Ongoing treatment with long-acting somatostatin analogues together with replacement with calcium carbonate, vitamin D3 and once weekly alendronic acid resulted in stable normal adjusted calcium levels over a 3-month follow-up period.
The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Megan
M
Symington
The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Louise
L
Davies
The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Gregory
G
Kaltsas
The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Martin O
MO
Weickert
D015746:Abdominal Pain / Q000209:etiology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery; D044584:Carcinoma, Ductal / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D010257:Paraneoplastic Syndromes; D010281:Parathyroid Hormone / Q000097:blood
D005765:Gastrointestinal Agents; D010281:Parathyroid Hormone; D015282:Octreotide