Letrozole Induced Hypercalcemia in a Patient with Breast Cancer

İpekçi, Süleyman Hilmi; Baldane, Süleyman; Öztürk, Ercüment; Araz, Murat; Korkmaz, Hüseyin Anıl; Çölkesen, Fatih; Kebapçılar, Levent

doi:10.1155/2014/608585

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Although expected, we did not confirm a relation between increased SCLs and duration of AI treatment. There are several case reports on hypercalcemia that appeared after treatment with AIs in patients with BC ( 8 , 9 ). In these reports, after exclusion of other possible causes, AI-related hypercalcemia was confirmed by ‘dechallenge and rechallenge’ AI-testing, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…In these reports, after exclusion of other possible causes, AI-related hypercalcemia was confirmed by ‘dechallenge and rechallenge’ AI-testing, i.e. a fall of SCLs after withdrawal and an increase after re-intake of anastrazole ( 8 ) or letrozole ( 9 ). The possible mechanisms by which AIs can cause hypercalcemia are unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Increased serum calcium levels (SCLs) in BC patients are most commonly caused by skeletal metastasis, followed by PHPT, and in a certain proportion of cases by the production of humoral factors of malignancy such as parathyroid hormone-related protein (PTHrP) ( 3 - 7 ). A few case reports describe that hypercalcemia mimicking PHPT is associated with the use of AI in hormone receptor-positive BC patients, but there is a lack of larger studies to confirm such relation ( 8 , 9 ). Studies that describe PHPT in BC patients are scarce and show conflicting results.…”

Section: Introductionmentioning

confidence: 99%

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Primary Hyperparathyroidism and Serum Calcium in Breast Cancer Patients Evaluated for Low Bone Mass – A Single Center Experience

Punda

Ovčariček

Tabain

et al. 2021

ACC

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SUMMARY The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary Hyperparathyroidism and Serum Calcium in Breast Cancer Patients Evaluated for Low Bone Mass – A Single Center Experience

Punda

Ovčariček

Tabain

et al. 2021

ACC

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“…As PTH levels in patients with PHPT typically increase after bisphosphonate treatment for hypercalcemia, the patient's parallel decrease of calcium and PTH levels after zoledronate and calcitonin treatment, and discontinuation of anastrozole further supports that anastrozole worsens PHPT. Mild hypercalcemia (11.0-11.8 mg/dL) has been reported in patients with breast cancer taking aromatase inhibitors (letrozole and anastrozole) [1][2][3]; all three patients have normal parathyroid function at baseline, but developed * Run Yu run.yu@cshs.org functional PHPT after initiation of the aromatase inhibitor. The mechanism of induction or worsening of PHPT by an aromatase inhibitor is not clear; it may be due to the decreased renal calcium clearance and stimulation of PTH secretion by interfering with the calcium-sensing receptors [3].…”

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confidence: 99%

Hypercalcemic crisis associated with anastrozole use in a patient with breast cancer and primary hyperparathyroidism

2016

Endocrine

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A 61-year-old woman was urgently referred to the endocrine clinic for hypercalcemic crisis. She had been diagnosed with mild primary hyperparathyroidism (PHPT) 16 months before ( Fig. 1) with a 24-hour urine calcium level of 276 mg (normal o250 mg), and a 1.4 × 0.9 × 0.9-cm parathyroid nodule. A few months later, as she was contemplating on potential parathyroidectomy, mammogram screening detected lobular carcinoma in situ of the left breast; she deferred parathyroidectomy and underwent left breast lumpectomy. Her breast cancer was positive for estrogen receptor, progesterone receptor, and HER-2. After surgery, she received radiation without chemotherapy. Twelve and half months after she was diagnosed with PHPT, she started adjuvant hormonal therapy with anastrozole 1 mg daily. At that point, her serum calcium levels had ranged between 11.0 and 11.4 mg/dL (normal 8.4-10.2). One month after starting anastrozole, she complained of progressive fatigue. Two and a half months later (16 months from the original diagnosis of PHPT), she developed lethargy, polyuria, and polydipsia. Her workup revealed calcium level 16.5 mg/dL, creatinine 1.5 mg/dL (normal 0.4-1.2) (baseline 0.9), albumin 4.3 g/dL (3.4-5.0), and globulin 2.7 g/dL (2.4-3.5) (Fig. 1). Her past medical history also included multinodular goiter, hypothyroidism, and hypertension. There had been no changes in her regular medications including levothyroxine, ergocalciferol, amlodipine, atorvastatin, omega-3 fatty acids, and ramipril. The patient was admitted for hypercalcemic crisis. Further testing showed free calcium level 2.10 mmol/L (1.12-1.23), PTH 714.4 pg/mL, PTH-related protein (PTHrp) 0.2 pmol/L (normal o 2), 25-hydroxyvitamin D 40 ng/mL (normal 30-100), 1,25-dihydroxyvitamin D 129 pg/mL (normal 18-72), and 24-h urine calcium 384 mg. Repeat thyroid ultrasound examination showed no change in the parathyroid nodule. Anastrozole was discontinued. She was treated with intravenous fluid, zoledronate 4 mg once, and calcitonin 350 units twice a day for 2 days. Her serum calcium and PTH levels decreased (Fig. 1). She underwent fine-needle aspiration of the parathyroid nodule and was discharged home. Cytological examination of the biopsy material confirmed the parathyroid origin. Seven weeks later, she underwent parathyroidectomy. Histological examination of the surgical specimen revealed hypercellular parathyroid gland with lesional cells within fibroconnective tissue and focal fibrous proliferation, which may be related to prior fine-needle aspiration. A year later, her calcium and PTH levels were both in the high-normal range.The patient was earlier diagnosed with mild PHPT, and her calcium levels had been only mildly elevated 3.5 months before the hypercalcemic crisis. Mild PHPT invariably progresses very slowly; a sudden and significant increase in calcium levels is highly unusual. The concurrent elevation of PTH and calcium levels after anastrozole use suggests that the worsening PHPT is likely caused by anastrozole. As PTH levels in patients with PHPT typ...

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“…Additionally, reports of hypercalcemia have been identified after initiation of the drug. 6 , 7 , 8 In the literature, there are no reports of AIs resulting in development of miliary osteoma cutis.…”

Section: Discussionmentioning

confidence: 99%

Two cases of treatment with aromatase inhibitors and development of miliary osteoma cutis—Is there an association?

et al. 2018

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Letrozole Induced Hypercalcemia in a Patient with Breast Cancer

Cited by 5 publications

References 18 publications

Primary Hyperparathyroidism and Serum Calcium in Breast Cancer Patients Evaluated for Low Bone Mass – A Single Center Experience

Primary Hyperparathyroidism and Serum Calcium in Breast Cancer Patients Evaluated for Low Bone Mass – A Single Center Experience

Hypercalcemic crisis associated with anastrozole use in a patient with breast cancer and primary hyperparathyroidism

Two cases of treatment with aromatase inhibitors and development of miliary osteoma cutis—Is there an association?

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