Acromegaly and non‐parathyroid hormone‐dependent hypercalcemia: a case report and literature review

BMC Endocrine Disorders

Yerong Yu¹  Chun Wang¹  Jianwei Li¹  Lan Zhang²  Shaomin Shi³ 

[1] Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 610041, Chengdu, China;Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 610041, Chengdu, China;Department of Endocrinology and Metabolism, Sixth People’s Hospital, First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, 400060, Chongqing, China;Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 610041, Chengdu, China;Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, 441000, Xiangyang, Hubei, China;

关键词: Hypercalcemia;    Growth hormone;    Prolactin;    Acromegaly;    Case report;   

DOI  :  10.1186/s12902-021-00756-z

来源: Springer

【 摘 要 】

BackgroundHypercalcemia associated with acromegaly is mostly parathyroid hormone (PTH)-dependent, being caused by parathyroid hyperplasia or adenoma, which are common in individuals with multiple endocrine adenomatosis-1 (MEN-1). The rare occurrence of non-PTH-dependent hypercalcemia associated with acromegaly is attributable to complex factors involving increased intestinal calcium absorption, enhanced bone calcium release, and reduced urinary calcium elimination. Although patients with acromegaly often have mild hyperphosphatemia and hypercalciuria, clinically significant hypercalcemia is extremely rare.Case presentationHere we present a case of non-PTH-dependent hypercalcemia associated with a growth hormone- (GH) and prolactin- (PRL) co-secreting pituitary macroadenoma. A 37-year-old Chinese man presented with a 6-year history of increasing ring and shoe sizes and was referred to the West China Hospital of Sichuan University for treatment of acromegaly. Pituitary magnetic resonance imaging (MRI) showed a 2.0 × 1.7 × 1.9 cm macroadenoma. Laboratory examinations revealed high serum concentrations of GH and PRL with mild hypercalcemia, hyperphosphatemia, hypercalciuria, inhibited PTH concentration, and increased bone turnover markers. Administration of cabergoline together with somatostatin resulted in sharp decreases in his GH, PRL, and serum and urinary calcium concentrations. These values were further reduced 5 months later and his PTH and bone turnover markers gradually returned to within the normal range.ConclusionsMild hyperphosphatemia and hypercalciuria are common in individuals with acromegaly and deserve attention because they may contribute to osteoporosis and urolithiasis. However, overt hypercalcemia is rare in such individuals. It is usually attributable to a coexisting parathyroid hyperplasia or adenoma, rarely being non-PTH-dependent. In such cases, the hypercalcemia is attributable to excessive PRL and hypogonadism and reverses with remission of acromegaly.

【 授权许可】

CC BY