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Calcitriol induced hypercalcemia - a rare phenomenon in lung cancer: A case report
Journal article   Open access

Calcitriol induced hypercalcemia - a rare phenomenon in lung cancer: A case report

Amulya Prakash, Farhan Khalid, Ahmad Alalwan, Husam Bader, Doantrang Du and Trishala Meghal
World journal of clinical oncology, v 14(11), pp 544-548
24 Nov 2023
DOI: https://doi.org/10.5306/wjco.v14.i11.544
PMID: 38059187
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.5306/wjco.v14.i11.544View
Published, Version of Record (VoR) Open

Abstract

Hypercalcemia associated malignancy Case report Vitamin D Denosumab Lung cancer Calcitriol
Calcitriol-induced hypercalcemia has been rarely reported in cases of lung cancer; however, it is frequently reported in cases of lymphoid malignancy and granulomatous disease. We present a rare case of hypercalcemia associated with squamous cell cancer of the lung with elevated calcitriol level. A 61-year-old Caucasian female with severe hypercalcemia of 15 mg/dL, which led to a new diagnosis of metastatic lung cancer. Since the parathyroid hormone-related peptide (PTHrP) level was minimally elevated at 2.1 pmol/L, we believe excessive calcitriol production by tumor cells was the underlying mechanism for hypercalcemia. Calcitriol was significantly elevated at 130 pg/mL with a low 25-hydroxyvitamin D level of 25.9 ng/mL and suppressed PTH level of 8 pg/mL. Corticosteroids are generally used to treat calcitriol-induced hypercalcemia, but we successfully treated our patient with bisphosphonate, highlighting the further utility of bisphosphonates in hypercalcemia treatment. We believe that the underlying cause of hypercalcemia, in this case of metastatic squamous cell lung carcinoma, was elevated calcitriol, which was likely produced by the tumor cells. In addition to PTHrP, calcitriol levels should be included in the workup for hypercalcemia in cases of lung cancer. However, the pathophysiology and prognostic significance of dysregulated calcitriol production in solid tumors remain unclear and warrant further research. Bisphosphonate may be used as a steroid-sparing therapy even in cases of calcitriol-induced hypercalcemia and warrants further investigation.

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