Endocrine Abstracts

Introduction: We report a patient with hypercalcaemia secondary to parathyroid hormone related peptide (PTHrp) from metastatic oesophageal cancer and co-existing primary hyperparathyroidism.

Case report: A 52-year-old lady was admitted to the hospital with a 2-week history of right scapula pain, reduced appetite and weight loss.

Blood test revealed an adjusted calcium of 3.99 nmol/l (NR 2.1–2.55 nmol/l), PTH of 147 ng/l (NR 15–65 ng/l), PTHrp of 4.3 pmol/l (NR 0.0–1.8 pmol/l) and normal myeloma screen. Normal 25-OH vitamin D levels and renal functions excluded the possible secondary PTH elevation.

CT scan showed evidence of lung and liver metastasis but the site of primary carcinoma could not be identified. Bone scan did not reveal any bony lesion. Liver biopsy confirmed metastatic carcinoma with possible lung or gastrointestinal tract (GI) as a primary site. She underwent an upper GI endoscopy which confirmed squamous cell cancer on oesophageal biopsy.

Hypercalcaemia initially responded well to intravenous fluid and bisphosphonate therapy and she was discharged home after noticeable clinical and biochemical improvement. She was readmitted with symptomatic hypercalcaemia resistant to further fluids and bisphosphonates. A trial of chemotherapy did not improve her hypercalcaemia and 2 months after her initial diagnosis, she passed away.

Conclusion: Hypercalcaemia is a common occurrence in malignancy and usually confer a poor prognosis. In our patient, hypercalcaemia was secondary to both metastatic oesophageal cancer and primary hyperparathyroidism. Primary hyperparathyroidism in this setting is mere an interesting observation and does not influence the course of patients’ treatment or outcome.

There have been case reports linking an association between metastatic breast cancer and primary hyperparathyroidism and their simultaneous presentation, but none have yet reported with metastatic oesophageal cancer.