Refractory Hypercalcemia in a Jamaican Woman

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Amaris Balitsky MSc, MD
Jonathan So, PhD, MD
Carolyn Chessex, MSc, MD

hypercalcemia, treatment of hypercalcemia, hyperparathyroidism,

Abstract

The two common differential diagnoses for hypercalcemia are malignancy and hyperparathyroidism. In this case of a young woman with hypercalcemia refractory to bisphosphonate treatment, Vitamin D and parathyroid hormone releasing peptide (PTHrP) levels were normal. She was found to be positive for HTLV-1 and later diagnosed with Adult T-cell leukaemia/ lymphoma, with CNS involvement. After treatment with R-CHOP therapy with intrathecal methotrexate, her symptoms improved and her calcium returned to normal. The differential diagnosis and treatment of hypercalcemia is further discussed.
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References

1. Shimomaya M. Diagnostic criteria and clinical subtypes of ATLL. A report from the Lymphoma Study Group (1984–87). Br J Haematol. 1991;79:428–37.

2. Qayyum, S. & Chol, JK. Adult T-cell leukemia/lymphoma. Arch Pathol Lab Med. 2014 Feb;138(2):282-6.

3. Yamaguchi K, Matutes E, Catovsky D, et al. Strongyloides stercoralis as candidate cofactor for HTLV-I induced malignancies. Lancet 1987;ii:94–5.

4. Matutes, E. Adult T-cell leukaemia/lymphoma. J Clin Pathol. 2007;60:1373– 1377

5. Shimoyama M. Treatment of patients with adult T-cell leukemia-lymphoma: an over- view. In: Advances in Adult T Cell Leukemia and HTLV-1 Research (Takatsuki K, Hinuma Y, Yoshida M, eds.). Tokyo: Japan Scientific Societies Press, 1992;39:43–56.

6. Bazarbachi A, Ghez D, Lepelletier Y, et al. New therapeutic approaches for adult T- cell leukaemia. Lancet Oncol. 2004;5:664–72.

7. Grill V and Martin TJ: Hypercalcemia of malignancy. Rev Endocr Metab Disord. 2000; 1: 245-263.

8. Walls J, Ratcliffe WA, Howell A, et al. Parathyroid hormone and parathyroid hormone- related protein in the investigation of hypercalcemia in two hospital populations. Clin Endocrinol (Oxf). 1994;41:407–13.

9. Lumachi F, Brunello A, Roma A, et al. Cancer-induced hypercalcemia. Anticancer Research. 2009;29:1551-1556.

10. Kunnathuparambil SG, Payangappadom PK, Yerol PK, et al. Hypercalcemic crisis due to adult T cell leukemia: a rare cause of paralytic ileus. Annals of Gastroenterolo- gy. 2012;25

11. Nosaka K1, Miyamoto T, Sakai T, et al. Mechanism of hypercalcemia in adult T-cell leukemia: over-expression of receptor activator of nuclear factor kappaB ligand on adult T-cell leukemia cells. Blood. 2002 Jan 15; 99:634-40.

12. Jibrin IM, Lawrence GD, Miller CB. Hypercalcemia of malignancy in hospitalized patients. Hospital Physician. 2006 Nov; 29-35. 13. Carrol MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003 May 1;67(9):1959-1966.