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Severe hypercalcaemia from ectopic intact parathyroid hormone secretion treated with continuous renal replacement therapy in a patient with two malignancies
  1. Nathaniel Hocker1,
  2. Maria Story2,
  3. Alysa Lerud3 and
  4. Sarat Kuppachi2
  1. 1Internal Medicine, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2Nephrology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3Pathology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Nathaniel Hocker; nathaniel-hocker{at}uiowa.edu

Abstract

We present a 61-year-old Caucasian woman with endometroid carcinoma as well as a poorly differentiated adenocarcinoma who developed severe hypercalcaemia in the setting of an elevated intact parathyroid hormone. The patient was hospitalised twice for her condition. During her first hospitalisation, she was diagnosed with an endometroid carcinoma and hypercalcaemia. With medical management, she had a normal calcium level on discharge. She presented 3 weeks later with hypercalcaemia and encephalopathy. This time her hypercalcaemia was refractory to medical management, and required continuous renal replacement therapy (CRRT) to normalise her serum calcium. Lung biopsy revealed a poorly differentiated adenocarcinoma, suspicious for pancreatic primary. Due to her poor prognosis, rapid elevation of calcium with each attempt to discontinue CRRT, and the poor options for treatment of her cancers, she elected to pursue hospice care.

  • dialysis
  • fluid electrolyte and acid-base disturbances
  • calcium and bone
  • endocrine cancer

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Footnotes

  • Contributors NH wrote the summary, background, case presentation, investigations, differential diagnosis, treatment, and outcome and follow-up sections; created the figure and did the majority of the literature review. MS wrote the discussion and learning points sections; did editing and assisted in writing out CRRT specifics. AL did literature search regarding PTH and PTH lab assays; and gave assistance with interpretation of biopsy results for patient’s endometrioid cancer and poorly differentiated carcinoma. SK was the mentor for writing the case report, did editing of various sections; and was involved in writing the discussion and conclusions to be made from the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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