Hypercalcemia of Malignancy Attributed to Cosecretion of PTH and PTHRP in Lung Adenocarcinoma

Jeffrey M. Kroopnick, MD; Ubaldo Martinez-Outschoorn, MD; Madalina Tuluc, MD, PhD; Caroline S. Kim, MD

AACE Clinical Case Reports (May 2021)

Hypercalcemia of Malignancy Attributed to Cosecretion of PTH and PTHRP in Lung Adenocarcinoma

Jeffrey M. Kroopnick, MD,
Ubaldo Martinez-Outschoorn, MD,
Madalina Tuluc, MD, PhD,
Caroline S. Kim, MD

Affiliations

Jeffrey M. Kroopnick, MD: Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland; Address correspondence and reprint requests to Dr. Jeffrey M. Kroopnick, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, 827 Linden Avenue, Baltimore, MD 21201.
Ubaldo Martinez-Outschoorn, MD: Department of Medical Oncology, Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
Madalina Tuluc, MD, PhD: Department of Pathology, Anatomy, and Cell Biology, Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
Caroline S. Kim, MD: Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Journal volume & issue: Vol. 7, no. 3
pp. 200 – 203

Abstract

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Introduction: Hypercalcemia of malignancy (HCM) portends a very poor prognosis, and no established guidelines exist regarding its management. Most instances of HCM are due to local osteolysis or secretion of parathyroid hormone related-peptide, while less than 1% of all cases are due to ectopic secretion of parathyroid hormone. Case Report: We present an unusual case of HCM due to proposed cosecretion of both parathyroid hormone and parathyroid hormone-related protein in a 36-year-old man with a poorly differentiated lung adenocarcinoma. The patient’s hypercalcemia was refractory to conventional measures, including intravenous bisphosphonate therapy (zoledronic acid), and was improved with administration of denosumab. Conclusion: This is the youngest and first case of hypercalcemia of malignancy attributed to cosecretion of PTH and PTHrP from an adenocarcinoma. In refractory cases of HCM, denosumab is a potential option when other conventional measures are unsuccessful.

Published in AACE Clinical Case Reports

ISSN: 2376-0605 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology
Website: https://www.journals.elsevier.com/aace-clinical-case-reports

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