title: Two cases of humoral hypercalcemia of malignancy complicating infantile fibrosarcoma.
abstract: We report two infants with infantile fibrosarcoma (IFS) complicated by severe hypercalcemia. Assessment demonstrated suppressed parathyroid hormone and 1,25-dihydroxyvitamin D levels with elevated circulating levels of parathyroid hormone related protein, indicating the diagnosis of humoral hypercalcemia of malignancy (HHM). HHM is a paraneoplastic syndrome rarely associated with pediatric malignancies. Hypercalcemia manifested clinically with neurologic symptoms and soft tissue calcium deposition and required aggressive management with intravenous fluids, diuretics, and supplemental electrolytes. Following treatment with neoadjuvant chemotherapy, serum calcium levels precipitously declined requiring calcium repletion. These cases highlight the improvement of hypercalcemia secondary to HHM following chemotherapy.
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hirschfeld
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Jennifer J G
authors.initials: JJG
authors.lastname: Welch
authors.affiliation: Division of Pediatrics, Department of Pediatric Care, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Robin
authors.initials: R
authors.lastname: Kremsdorf
authors.affiliation: Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Anjulika
authors.initials: A
authors.lastname: Chawla
mesh_terms: D002118:Calcium / Q000097:blood; D005260:Female; D005354:Fibrosarcoma / Q000097:blood / Q000628:therapy; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D020360:Neoadjuvant Therapy; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000628:therapy; D010281:Parathyroid Hormone / Q000097:blood*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; D002118:Calcium
keywords: chemotherapy; humoral hypercalcemia; pediatric hematology/oncology; soft tissue sarcoma