Hypercalcemia in metastatic GIST caused by systemic elevated calcitriol: a case report and review of the literature

BMC Cancer

Case Report

Bente Lomholt Langdahl¹  Katrine Hygum¹  Torben Harsløf¹  Anders Kindberg Boysen²  Philip Blach Rossen²  Christian Nielsen Wulff²  Akmal Ahmed Safwat² 

[1] Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000, Aarhus, C, Denmark;Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus, C, Denmark;

关键词: Hypercalcemia;    Systemic hypervitaminosis D;    Calcitriol;    GIST;   

DOI  :  10.1186/s12885-015-1823-7

 received in 2015-05-12, accepted in 2015-10-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundHypercalcemia is the most common oncologic metabolic emergency but very rarely observed in patients with gastrointestinal stromal tumour, which is a rare mesenchymal malignancy of the gastrointestinal tract. We describe a case of hypercalcemia caused by elevated levels of activated vitamin D in a patient with gastrointestinal tumour. Prior to this case report, only one paper has reported an association between hypercalcemia, gastrointestinal stromal tumours and elevated levels of vitamin D.Case presentationAn otherwise healthy 70-year-old Caucasian woman, previously treated for duodenal gastrointestinal stromal tumour, was diagnosed with liver metastasis, and relapse of gastrointestinal stromal tumour was confirmed by biopsy. At presentation, the patient suffered from severe symptoms of hypercalcemia. The most common causes of hypercalcemia, hyperparathyrodism, parathyroid hormone-related peptide secretion from tumour cells, and metastatic bone disease, were all dismissed as the etiology. Analysis of vitamin D subtypes revealed normal levels of both 25-OH Vitamin D2 and 25-OH Vitamin D3, whereas the level of activated vitamin D, 1,25 OH Vitamin D3, also referred to as calcitriol, was elevated.ConclusionThe fact that plasma calcitriol decreased after initiation of oncological treatment and the finding that hypercalcemia did not recur during treatment support the conclusion that elevated calcitriol was a consequence of the gastrointestinal stromal tumour. We suggest that gastrointestinal stromal tumours should be added to the list of causes of humoral hypercalcemia in malignancy, and propose that gastrointestinal stromal tumour tissue may have high activity of the specific enzyme 1α-hydroxylase, which can lead to increased levels of calcitriol and secondarily hypercalcemia.

【 授权许可】

CC BY   
© Hygum et al. 2015