Calcitriol-mediated hypercalcemia in a patient with bilateral adrenal non-Hodgkin's B-cell lymphoma case report

Abaroa-Salvatierra, Ana; Shaikh, Bilal; Deshmukh, Mrunalini; Alweis, Richard; Patel, Ajay Kumar

doi:10.3402/jchimp.v6.30381

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…In PAL, the treatment for the hypercalcemia relies on treating the underlying tumor. The patient in our case experienced significant improvement in serum calcium with R-CHOP therapy and remained normocalcemic during several months of follow-up after R-CHOP completion, whereas the patient described by Abaroa-Salvatierra et al (19) required additional therapy for hypercalcemia, including calcitonin and pamidronate, and succumbed 3 months after initiation of chemotherapy with rituximab, cyclophosphamide, vincristine, and prednisone.…”

Section: Discussionmentioning

confidence: 50%

“…As a result, PTH was suppressed and serum PTHrP was not elevated. Abaroa-Salvatierra et al (19) recently reported another PAL case with calcitriol-mediated hypercalcemia and increased angiotensin-converting enzyme (ACE) level. A potential etiology to consider is the interaction between the local chemokine-matrix with the surrounding tissue macrophages, similar to what has been reported in sarcoidosis (20).…”

Section: Discussionmentioning

confidence: 99%

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The Diverse Clinical Presentations of Adrenal Lymphoma

Masood

Tumyan

Nussenzveig

et al. 2017

AACE Clinical Case Reports

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Objective: Adrenal lymphoma is a rare and aggressive form of non-Hodgkin lymphoma (NHL). We report 2 cases of adrenal lymphoma: one with typical symptoms of adrenal insufficiency, the other with the unusual presentation of symptomatic hypercalcemia from 1,25-dihydroxyvitamin D (1,25-[OH] 2-D) excess. Methods: A comparison of the clinical presentation of 2 patients diagnosed with primary adrenal diffuse large B cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is reported. Results: The first patient was a 72-year-old man who presented with weight loss, hypotension, and bilateral adrenal masses. He was diagnosed with adrenal insufficiency from stage IVB DLBCL with primarily adrenal involvement. Treatment with 6 cycles of R-CHOP led to near-complete regression of adrenal masses and clinical remission, but with continued need for adrenocortical hormone replacement. He eventually succumbed to recurrent DLBCL with brain metastasis. The second patient was a 65-year-old man who presented with nausea, vomiting, constipation, and weight loss. He was noted to have hypercalcemia due to elevated serum 1,25-(OH) 2-D, bilateral large adrenal masses, but normal serum cortisol. He was diagnosed with stage II DLBCL. Treatment with R-CHOP led to complete remission with resolution of hypercalcemia. Conclusion: Primary adrenal DLBCL is an aggressive and rare type of NHL. While adrenal insufficiency is expected in this clinical scenario, hypercalcemia from 1,25-(OH) 2-D excess is an uncommon presentation. R-CHOP treatment may improve outcomes but more studies are needed to establish the optimal treatment for this rare disease entity. (AACE Clinical Case Rep. 2017;3:e307-e312) Abbreviations: 1,25-(OH) 2-D = 1,25-dihydroxyvitamin D; CNS = central nervous system; CT = computed tomography; DLBCL = diffuse large B cell lymphoma; FDG = fluorodeoxyglucose; HU = Hounsfield units; MRI = magnetic resonance imaging; NHL = non-Hodgkin lymphoma; PAL = primary adrenal lymphoma; PET = positron emission tomography; PTH = parathyroid hormone; PTHrP = parathyroid hormone-related peptide; R-CHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone; SUVmax = maximum standardized uptake value e308 The Diversity of Adrenal Lymphoma, AACE Clinical Case Rep. 2017;3(No. 4)

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

The Diverse Clinical Presentations of Adrenal Lymphoma

Masood

Tumyan

Nussenzveig

et al. 2017

AACE Clinical Case Reports

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“…Primary diffuse large B-cell lymphoma of the adrenal gland (PADLBCL) is a rare malignant tumor with a poor prognosis, and its pathogenesis is unclear. One view is that it originates from the hematopoietic tissue of the adrenal gland, [ 3 ] which requires further investigation. The clinical symptoms of primary diffuse large B-cell lymphoma (PADLB) are varied and not clearly specific.…”

Section: Discussionmentioning

confidence: 99%

Primary diffuse large B-cell lymphoma of adrenal gland: A case report

Ou,

Wang,

Jia

et al. 2024

Medicine

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Introduction: Most adrenal tumors are benign and primary adrenal malignancies are relatively rare. Primary adrenal lymphoma (PAL) is a very rare and highly aggressive malignant tumor with unknown etiology, atypical clinical symptoms, nonspecific imaging manifestations, difficult disease diagnosis and poor prognosis. Case report: This case report details a 42-year-old woman who was admitted to the hospital with a 1-year-old bilateral adrenal mass and 1-month-old left upper abdominal pain. Enhanced CT of the abdomen showed a right adrenal nodule and a large occupying lesion in the left adrenal region, with a high probability of pheochromocytoma. Intraoperatively, a huge tumor measuring about 12*12*10 cm was found in the left adrenal region, infiltrating the left kidney, spleen and pancreatic tail. Postoperative pathology: lymphocytes were found in the renal capsule and subcapsule, lymphocytes were found in the pancreas; lymphocytes were found in the spleen. Consider a tumor of the lymphohematopoietic system, possibly lymphoma. Conclusion: This case demonstrates that primary adrenal diffuse large B-cell lymphoma (PADLBCL) is highly aggressive, has a poor prognosis, is prone to recurrence, has poor therapeutic outcomes, and is difficult to diagnose. Clinicians should consider the possibility of PADLBCL when encountering huge adrenal-occupying lesions and consider chemotherapy before surgery. Reducing the tumor size before surgery is a more favorable therapeutic approach, thus prolonging the patient life and improving the quality of survival.

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“…Our patient's presentation was atypical for non-Hodgkin's lymphoma and further complicated the diagnostic approach to the patient's hypercalcemia. Calcitriol-mediated hypercalcemia is the most common cause of hypercalcemia in hematological malignancies and is recognized as a distinct syndrome in Hodgkin's disease and non-Hodgkin's lymphoma [8,9]. Patients with malignancy-associated hypercalcemia are usually symptomatic, which adds significant risk to these patients' morbidity and mortality and may induce oncologic emergencies.…”

Section: Discussionmentioning

confidence: 99%

An Exciting Case of Acute on Chronic Hypercalcemia in the Setting of Chronic Primary Hyperparathyroidism: A Case Report and Diagnostic Approach

Khan¹,

Rattray²,

Masud³

et al. 2022

Cureus

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Acute worsening of hypercalcemia in patients with chronic primary hyperparathyroidism can be challenging, and availability bias may mislead physicians to diagnose worsening primary hyperparathyroidism, especially if the parathyroid hormone is also trending higher. We report a case of stage-IV non-Hodgkin's lymphoma which presented as acute worsening of hypercalcemia in a patient with chronic primary hyperparathyroidism.

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Calcitriol-mediated hypercalcemia in a patient with bilateral adrenal non-Hodgkin's B-cell lymphoma case report

Cited by 5 publications

References 14 publications

The Diverse Clinical Presentations of Adrenal Lymphoma

The Diverse Clinical Presentations of Adrenal Lymphoma

Primary diffuse large B-cell lymphoma of adrenal gland: A case report

An Exciting Case of Acute on Chronic Hypercalcemia in the Setting of Chronic Primary Hyperparathyroidism: A Case Report and Diagnostic Approach

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