Hypercalcemia of Malignancy: Simultaneous Elevation in Parathyroid Hormone-Related Peptide and 1,25 Dihydroxyvitamin D in Sarcoma

Dong Won Kim; Ann Miller; Andrew Li; Naomi Hardy; Kristi D Silver

doi:10.1016/j.aace.2020.11.037

Hypercalcemia of Malignancy: Simultaneous Elevation in Parathyroid Hormone-Related Peptide and 1,25 Dihydroxyvitamin D in Sarcoma

AACE Clin Case Rep. 2021 Jan 7;7(3):169-173. doi: 10.1016/j.aace.2020.11.037. eCollection 2021 May-Jun.

Authors

Dong Won Kim¹, Ann Miller², Andrew Li¹, Naomi Hardy³, Kristi D Silver²

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
² Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
³ Division of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.

Abstract

Objective: Hypercalcemia is a common finding in patients who have an underlying malignancy. Only a few cases of hypercalcemia of malignancy have been linked to more than one mechanism of hypercalcemia. Here, we present a patient with liposarcoma and hypercalcemia of malignancy in the setting of simultaneous elevations in parathyroid hormone-related peptide (PTHrP) and 1,25 dihydroxyvitamin D [1,25(OH)₂D] levels. Sarcoma-associated hypercalcemia is a rare disorder.

Methods: The patient was an 89-year-old woman with sarcoma-associated hypercalcemia. Multiple mechanisms were uncovered, and treatments were adjusted for them. Literature search for hypercalcemia of malignancy with multiple mechanisms was conducted.

Results: This is the first report describing dual mechanisms of sarcoma-associated hypercalcemia and only the fifth report on PTHrP and 1,25(OH)₂D simultaneously causing hypercalcemia of malignancy.

Conclusion: Based on this finding, we recommend measuring the 1,25(OH)₂D levels in conjunction with the PTHrP level in patients with malignancy as this would allow for a more proactive approach to the diagnosis and treatment of hypercalcemia of malignancy.

Keywords: 1,25 dihydroxyvitamin D; 1,25(OH)2D, 1,25 Dihydroxyvitamin D; PTHrP; PTHrP, parathyroid hormone-related peptide; hypercalcemia of malignancy; sarcoma.

Publication types

Case Reports