Abstract
Hypercalcemia in children is a rare condition and may result from various etiologies, such as genetic, metabolic, iatrogenic causes and malignancy. In some malignancies, parathyroid hormone related protein (PTHrP) can mimic the physiological effects of parathyroid hormone (PTH) and cause hypercalcemia. In this report , we present a rare case of hypercalcemia secondary to juvenile fibroadenoma, a benign breast tumor. A 14-year-old girl presented with the complaint of a solid breast mass. Following evaluation with ultrasonography and trucut biopsy, a diagnosis of 14x8 cm juvenile fibroadenoma was made. Laboratory examination revealed hypercalcemia (13.9 mg/dL) and high PTHrP (>24.8 ng/L) although the patient was asymptomatic. Despite pharmacological treatment, the patient continued to experience persistent hypercalcemia and subsequently underwent a successful surgical excision. Serum calcium and PTHrP levels normalized postoperatively. Hypercalcemia secondary to malignancy in children is rare and calcium elevation is usually mild-moderate and asymptomatic. In this case, PTHrP was elevated in a girl with breast fibroadenoma, demonstrating that hypercalcemia can also be associated with benign tumors. The follow-up data after surgical treatment supports the suggestion that PTHrP-related hypercalcemia does not always indicate a poor prognosis. This case demonstrates the importance of considering benign tumors, such as juvenile fibroadenoma, as a potential cause of hypercalcemia in adolescents.
Keywords: Hypercalcemia, juvenile fibroadenoma, parathyroid hormone-related protein
Read the full text
4 sections · 3 figures · 1 table · PDF
Create your free account to read the full text.
- Full text with figures and tables
- PDF and supplementary files
- Access on every Galenos journal
One Galenos account works on every Galenos journal site.
References
Stokes VJ, Nielsen MF, Hannan FM, Thakker RV. Hypercalcemic disorders in children. J Bone Miner Res. 2017;32:2157-2170. Epub 2017 Nov 2
Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr. 2010;22:508-515.
Ratcliffe WA, Hutchesson AC, Bundred NJ, Ratcliffe JG. Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia. Lancet. 1992;339:164.
Ikeda K, Ohno H, Hane M, Yokoi H, Okada M, Honma T, Yamada A, Tatsumi Y, Tanaka T, Saitoh T. Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma. J Clin Endocrinol Metab. 1994;79:1322.
Horwitz MJ, Tedesco MB, Sereika SM, Hollis BW, Garcia-Ocaña A, Stewart AF. comparison of sustained infusion of human parathyroid hormone-related protein-(1-36) [hPTHrP-(1-36)] versus hPTH-(1-34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers. J Clin Endocrinol Metab. 2003;88:1603-1609.
Greydanus DE, Matytsina L, Gains M. Breast disorders in children and adolescents. Prim Care. 2006;33:455-502.
De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, part 2: breast masses. J Pediatr Adolesc Gynecol. 2006;19:415-418.
Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I, Mitropoulou G, Christopoulos P. Giant juvenile fibroadenoma: case report and review of the literature. J Clin Med. 2023;12:1855.
Lafferty FW. Differential diagnosis of hypercalcemia. J Bone Miner Res. 1991;6(Suppl 2):S51-S59; discussion S61.
Asonitis N, Angelousi A, Zafeiris C, Lambrou GI, Dontas I, Kassi E. Diagnosis, pathophysiology and management of hypercalcemia in malignancy: a review of the literature. Horm Metab Res. 2019;51:770-778. Epub 2019 Dec 11
Sheehan MT, Li YH, Doi SA, Onitilo AA. Evaluation of diagnostic workup and etiology of hypercalcemia of malignancy in a cohort of 167 551 patients over 20 years. J Endocr Soc. 2021;5:bvab157.
Jemtland R, Rian E, Gautvik KM. Malignhumoral hyperkalsemi og det parathormonrelaterte protein [Malignant humoral hypercalcemia and the parathyroid hormone related protein]. Tidsskr Nor Laegeforen. 1991;111:1738-1742. Norwegian.
Gardin JP, Paillard M. Hypercalcémie humorale des néoplasies: rôle du parathormone-related peptide (PTH-rp) [Humoral hypercalcemia in neoplasias: role of parathyroid hormone related peptide (PTH-rp)]. Rev Prat. 1991;41:347-349. French.
Wimalawansa SJ. Significance of plasma PTH-rp in patients with hypercalcemia of malignancy treated with bisphosphonate. Cancer 1994;73:2223-2230.
Pecherstorfer M, Schilling T, Blind E, Zimmer-Roth I, Baumgartner G, Ziegler R, Raue F. Parathyroid hormone-related protein and life expectancy in hypercalcemic cancer patients. J Clin Endocrinol Metab. 1994;78:1268-1270.
Edwards RC, Ratcliffe WA, Walls J, Morrison JM, Ratcliffe JG, Holder R, Bundred NJ. Parathyroid hormone-related protein (PTHrP) in breast cancer and benign breast tissue. Eur J Cancer. 1995;31A:334-339.
