Endocrine Abstracts

Fourth-two years old female patient was diagnosed with carcinoma left breast in 2003. She had mastectomy of left breast and axillary clearance followed by adjuvant radiotherapy and chemotherapy. Histology showed ER positive. She was commenced on anastrozole. She suffered from back pain in 2005. Investigations revealed she had spinal metastases as well as left ureteric stone and hydronephrosis of left kidney. She had a left ureteric stent and her back pain was relived. USG kidneys showed several small stones in both kidneys.

Her back pain recurred in 2006 and she was found to have progressive bone metastases even on regular chemotherapy and hormonal therapy. Her calcium was found to be elevated. She was being treated with regular pamidronate infusion. Despite that, she had persistent hypercalcaemia with corrected calcium level between 2.8 to 3 mmol/l. Her blood urea and creatinine levels were always within normal range. She was treated as hypercalcaemia due to bone metastasis for nearly a year.

In 2007, all her symptoms improved but mild hypercalcaemia remained. Her PTH level was checked for first time in 2007 because of persistent hypercalcaemia. He PTH level was elevated at 12 pmol/l. Her alkaline phosphatase levels were always normal. She was referred to our endocrine clinic.

She was proceeded to have parathyroid scan and that revealed she had single parathyroid adenoma in the right lower pole of thyroid gland.

We conclude that metastatic breast carcinoma is the most likely aetiology of hypercalcaemia in this patient; the second aetiology shouldn’t be overlooked.