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Published in: BMC Endocrine Disorders 1/2021

Open Access 01-12-2021 | Rectal Cancer | Case report

Severe hypercalcemia caused by parathyroid hormone in a rectal cancer metastasis: a case report

Authors: Vegard Heimly Brun, Erik Knutsen, Helge Stenvold, Hanne Halvorsen

Published in: BMC Endocrine Disorders | Issue 1/2021

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Abstract

Background

Hypercalcemia of malignancy is relatively common in several cancers. However, in colorectal cancer, paraneoplastic phenomena that cause hypercalcemia is uncommon. In the few cases that are reported, secretion of parathyroid hormone-related peptide mediates the effect. We describe the first case of severe hypercalcemia mediated by intact parathyroid hormone secretion from a bone metastasis of colorectal origin. This was a diagnostic and therapeutic challenge.

Case presentation

A 68-year-old male treated for rectal adenocarcinoma 10 years earlier developed a bone metastasis. After initial treatment of the metastasis with surgery and irradiation, he developed a relapse with severe hypercalcemia and corresponding elevated parathyroid hormone levels. The workup showed no signs of parathyroid adenomas, but the metastasis produced intact parathyroid hormone. The hypercalcemia was successfully treated by irradiation and osteoclast inhibitor, and the patient received chemotherapy. Survival was 24 months from the onset of hypercalcemia.

Conclusions

Proper diagnosis of the uncommon endocrine disturbance allowed targeted therapy and avoidance of neck exploration for wrongly suspecting primary hyperparathyroidism. Intact parathyroid hormone should be measured in cases of malignant hypercalcemia.
Appendix
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Footnotes
1
RNA Isolation, cDNA Synthesis, and RT-qPCR. 
Total RNA was isolated from FFPE tissue sections using the High Pure FFPE tissue RNA Isolation kit (Roche) according to the manufacturer’s recommendation. RNA concentration was measured by Qubit (Thermo Fisher Scientific). Complementary deoxyribonucleic acid (cDNA) synthesis of total RNA was performed with SuperScript™ IV Reverse Transcriptase (ThermoFisher Scientific). 2.5 μM of random hexamer primer (ThermoFisher Scientific) and approximately 80 ng of template were used for the reaction. Total RNA was denaturated at 65 °C for 5 min, and cDNA was synthesized at 53 °C for 10 min. For real-time quantitative polymerase chain reaction (RT-qPCR), cDNA was mixed with FastStart Essential DNA Green Master (Roche Life Science) and 0.25 μM forward and reverse primer. All primer sequences are provided in Supplementary Table 1. The LightCycler® 96 was used for quantification, and the ΔΔCq-method was used to calculate fold change using the geometric mean of housekeeping genes (GAPDH and RPLPO) as internal reference.
 
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Metadata
Title
Severe hypercalcemia caused by parathyroid hormone in a rectal cancer metastasis: a case report
Authors
Vegard Heimly Brun
Erik Knutsen
Helge Stenvold
Hanne Halvorsen
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-020-00664-8

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