Journal of

Case Reports and Images in Oncology

 
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Case Report
 
Refractory hypercalcemia of malignancy related to vitamin D toxicity: Treatment strategies
Mohammed Athar Naeem1, JoAnn Roslyn Phillips2, Patrick Michael Dillon3
1Oncology Fellow, University of Virginia, Charlottesville, VA, USA.
2Oncology Navigator, University of Virginia, Charlottesville, VA, USA.
3Associate Professor of Oncology, University of Virginia, Charlottesville, VA, USA.

Article ID: 100025Z10MN2016
doi:10.5348/Z10-2016-25-CR-16

Address correspondence to:
Patrick Dillon
MD Associate Professor, UVA Division of Hematology/Oncology
UVA Box 800716
Charlottesville, VA 22908
United States

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How to cite this article:
Nashwan AJ, Elmalik HH, Nair SLK, Yassin MA. Refractory hypercalcemia of malignancy related to vitamin D toxicity: Treatment strategies. J Case Rep Images Oncology 2016;2:66–70.


Abstract
Introduction: Hypercalcemia of malignancy (HCM) is a known cancer complication resulting in morbidity and mortality. It is most often mediated by parathyroid hormone related peptide (PTHrP) or direct bone invasion, but may be related to other humoral causes. Most cases of HCM respond to standard therapies such as fluids, loop diuretics, bisphosphonates, calcitonin, denosumab and control of the underlying malignancy.
Case Report: This report describes the case of a 60-year-old woman with metastatic breast cancer and vitamin D toxicity who developed PTHrP driven HCM. The case is a unique example of breast cancer related HCM in the absence of bone metastases. The hypercalcemia was refractory to standard treatments including intravenous bisphosphonates, fluids and calcitonin. Ultimately, the patient responded to denosumab dosed every seven days along with daily intravenous hydration. Response was maintained despite failure to control the underlying malignancy.
Conclusion: Vitamin D toxicity may exacerbate PTHrP driven HCM. Frequent dosing of denosumab is shown to be safe and effective in refractory HCM. The mechanisms and management of vitamin D toxicity are reviewed.

Keywords: Hypercalcemia of malignancy, Osteoprotegerin (OPG), Parathyroid hormone related peptide (PTHrP), Receptor activator of nuclear factor kappa beta ligand (RANKL), Vitamin D


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Author Contributions
Mohammed Athar Naeem – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
JoAnn Roslyn Phillips – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Patrick Michael Dillon – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Mohammed Athar Naeem et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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