Endocrine Abstracts

Introduction: The aim of this report is to present the uncommon clinical presentation of a patient with a pancreatic NET.

Case report: A 55-year-old man with personal history of hypertension, dyslipidaemia, and depression. He was referred to the outpatient for high levels of calcium in repeated assessments during the last year. He referred polyuria and polydipsia. Not clinical history of bone fractures, abdominal pain, or another digestive symptoms. Initial biochemical assessment demonstrated: calcium 11.8 mg/dl (8.5–10.5), phosphate 2.4 mg/dl (2.5–4.5), creatinine 0.68 mg/dl, GGT 121 U/l, FA 182 U/l, PTHi 7 pg/ml (10–65), 25-OH-vit D 8.78 ng/ml (>20), 1,25-OH-vit D 98.8 pg/ml (16–56), ECA 26 U/l (8–52), calciuria 545 mg/day (<400), chromogranin A 152 ng/ml (<100), and rPTH 1.5 pmol/l (<1). Proteinogram and bone scintigraphy negative. Abdominal CT, revealed a 6.6-cm lobular mass at the tail of the pancreas with collateral circulation and multiple focal liver lesions, which occupied 70% of the hepatic parenchyma. Somatostatin receptor scintigraphy exhibited multiple lesions that overexpress somatostatin receptors suggestive of multiple hepatic metastases from neuroendocrine tumor, without pancreatic uptake. Percutaneous FNA (guided by endoscopy) of the pancreatic lesion revealed a well-differentiated NET. Initially, octreotide long-acting release (LAR) 20 mg every 28 days was administrated and calcium levels decreased from 13.7 to 9.4 mg/dl in 3 months. After that, calcium levels increased again so we increased octreotide LAR 30 mg every 28 days, and then every 15 days, but due to biochemical progression everolimus treatment was initiated. After 2 years treatment with SA and 1 year with everolimus there has not been radiological progression. The patient is clinically asymptomatic.

Conclusion: The manifestation of paraneoplastic syndrome due to PTHrP hypersecretion, despite its rareness in NET, should be considered in the differential diagnosis of hypercalcaemia in such tumours.