Intractable Hypercalcemia Due to a Metastatic Carcinoid Secreting Parathyroid Hormone-Related Peptide and Interleukin-6: Response to Octreotide

Barhoum, Maan; Hutchins, Laura F.; Fonseca, Vivian

doi:10.1097/00000441-199909000-00019

Cited by 13 publications

(17 citation statements)

References 6 publications

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“…In single case reports a clear biochemical response following administration of octreotide has been documented with evidence of normalisation of calcium [19, 20]. The duration of this effect is unclear, since nearly all patients in our case series have progressed in spite of treatment with long-acting octreotide preparations.…”

Section: Discussionmentioning

confidence: 83%

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Parathyroid Hormone-Related Peptide-Secreting Pancreatic Neuroendocrine Tumours: Case Series and Literature Review

Srirajaskanthan¹,

McStay²,

Toumpanakis³

et al. 2008

Neuroendocrinology

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Background/Aims: Parathyroid hormone-related peptide (PTHrP) was discovered in 1987 as the tumour product responsible for humoral hypercalcaemia of malignancy (HHM). Pancreatic neuroendocrine tumours (NETs) are uncommon malignancies with an incidence of 1:100,000 population. PTHrP-secreting NETs are rare but are being recognised as a cause of HHM in NETs. We describe the largest series to date and the management of these rare tumours. Methods: One male and 4 female patients were seen in our unit from 1998 to 2006. The average duration of follow-up was 86 months from initial diagnosis. All patients had a histologically confirmed diagnosis of pancreatic NET, all of which were low-grade tumours. PTHrP assay was performed in 4 of 5 cases and was elevated in these patients. Results: Initial management involved surgery in 2 of 5 cases, whilst 2 cases underwent chemotherapy and 1 case was commenced on interferon-α. We discuss the further therapies that all patients underwent and the complexities that arose in managing disease progression as well as resistant hypercalcaemia. Conclusion: PTHrP-secreting tumours should be considered in the differential diagnosis of patients with NETs who present with hypercalcaemia and a disproportionately low PTH. PTHrP tumours may well be underestimated as the assay is difficult to perform and may not be requested. In hypercalcaemic patients the standard management acutely includes intravenous fluids, diuretics and intravenous bisphosphonate. In the further management, somatostatin analogue therapy is the first medical option to consider and we discuss the role of other therapies.

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Section: Discussionmentioning

confidence: 83%

“…The role of SST analogues in controlling hypercalcaemia has been described previously in case reports [19]. In single case reports a clear biochemical response following administration of octreotide has been documented with evidence of normalisation of calcium [19, 20].…”

Section: Discussionmentioning

confidence: 98%

Parathyroid Hormone-Related Peptide-Secreting Pancreatic Neuroendocrine Tumours: Case Series and Literature Review

Srirajaskanthan¹,

McStay²,

Toumpanakis³

et al. 2008

Neuroendocrinology

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“…In addition to diarrhea, other typical symptoms of the carcinoid syndrome are cutaneous flushing, bronchospasm, and right-sided heart disease [4]. Hypercalcemia has been reported in association with carcinoid tumors in a total of 16 cases since 1966 [5,6,7,8]. Putative explanations for the hypercalcemia have included the production of PTHrp by tumor cells; direct osteolysis by bone metastases; co-existent primary hyperparathyroidism, as part of a multiple endocrine neoplasia syndrome; and elevated calcitonin levels.…”

Section: Discussionmentioning

confidence: 99%

A Case of Carcinoid Tumor-Associated Hypercalcemia

Siyam

Abdullah²,

Gardner³

et al. 2012

Cardiorenal Med

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Hypercalcemia as a complication of carcinoid tumors is extremely rare. Accordingly, we report the case of a 55-year-old male with metastatic carcinoid tumor and hypercalcemia, which corrected when the patient was treated with octreotide for symptomatic relief of watery diarrhea. The etiology of the hypercalcemia is presumed to be a neoplastic expression of fibroblast growth factor-23, which was found to be inappropriately high-to-normal when other factors such as parathyroid hormone, calcitonin and vitamin D were appropriately low or low-to-normal.

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“…Several pro-inflammatory cytokines have been implicated in the development of carcinoid tumors [75,76,77,78,79,80], and in case of metastatic carcinoids an additional prognostic role of cytokines was noticed [81]. …”

Section: Cytokine Genetics In Gep-netsmentioning

confidence: 99%

New Insights into the Role of Chronic Inflammation and Cytokines in the Etiopathogenesis of Gastroenteropancreatic Neuroendocrine Tumors

Berković

Čačev

Ivković³

et al. 2014

Neuroendocrinology

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Although previously considered rare, recent epidemiological studies have revealed that the incidence (3.6/100,000) and prevalence (35/100,000) of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has increased over the past few decades. Despite the progress in the understanding of GEP-NET molecular biology, there is still little advance in the early diagnosis due to lack of specific tumor markers. As the tumors are mostly detected in their late stage, they are not well controlled by either biotherapy or conventional chemotherapy, and thus represent a significant clinical issue. Chronic inflammation has been implicated in the development of GEP-NETs. This review presents recent findings that link pro-inflammatory cytokines to the molecular basis of GEP-NET tumorigenesis, leading to a more personalized approach to disease management and therapy.

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Intractable Hypercalcemia Due to a Metastatic Carcinoid Secreting Parathyroid Hormone-Related Peptide and Interleukin-6: Response to Octreotide

Cited by 13 publications

References 6 publications

Parathyroid Hormone-Related Peptide-Secreting Pancreatic Neuroendocrine Tumours: Case Series and Literature Review

Parathyroid Hormone-Related Peptide-Secreting Pancreatic Neuroendocrine Tumours: Case Series and Literature Review

A Case of Carcinoid Tumor-Associated Hypercalcemia

New Insights into the Role of Chronic Inflammation and Cytokines in the Etiopathogenesis of Gastroenteropancreatic Neuroendocrine Tumors

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