Hypercalcemia due to Nasopharyngeal Carcinoma

Abstract

Hypercalcemia is one of rare metabolic disorders associated with hyperparathyroidism, malignancy and various other causes. Although common in adult malignancies, hypercalcemia is rare in pediatrics and purports poor prognosis. Nasopharyngeal carcinoma is rare with no reported hypercalcemic presentation. We present here a case of hypercalcemia in a child of nasopharyngeal carcinoma. A 10 year girl presented with backache for 1 month, epistaxis, cough, chest pain for 1 week alongwith anorexia and weight loss. Investigations revealed anemia and hypercalcemia (23mg/dl; normal range 9-11 mg/dl) with hyperphosphatemia, normal parathyroid levels. Hypercalcemic crisis was managed with saline, furosemide and bisphosphonate. Computed Tomography of paranasal sinuses revealed mass in right nasal cavity. Endoscopic biopsy disclosed undifferentiated nasopharyngeal carcinoma and the child expired. Thus, hypercalcemia, though rare, may complicate advanced tumors. NPC, being rare in children, requires high index of suspicion with careful clinicoradiological examination and timely management for better chances of survival.

Laboratory Profiles of Nasopharyngeal Carcinoma Patients

“…A study in 2020 reported that lower calcium levels are related to worse prognosis than those with high calcium levels [23]. The mechanism of hypercalcemia in NPC includes humoral hypercalcemia due to the secretion of Parathyroid Hormone Related Peptide (PTHrP), osteolytic bone metastases, and the activation of 1-αhydrolase leading to the increase of calcitriol [24].…”

Regulation of cellular senescence by eukaryotic members of the FAH superfamily – A role in calcium homeostasis?

“…There are several studies connecting these organs to calcium homeostasis and regulation ( Brown and Vaidya, 2014 ; Ambudkar, 2016 ). The nasopharynx (displaying high levels of FAHD1) is usually not associated with calcium regulation, however, there is a recent documentation of a rare case of nasopharynx carcinoma because of hypercalcemia ( Chaudhary and Sah, 2020 ). In contrast, detected FAHD protein levels are generally low in tissues that are not associated to calcium homeostasis Table 5 .…”