A Case of Hypercalcemia from PTHrP-Producing Fibromyxoid Sarcoma Responsive to Glucocorticoid Therapy

Calcif Tissue Int. 2023 Aug;113(2):246-253. doi: 10.1007/s00223-023-01099-8. Epub 2023 Jun 26.

Abstract

The treatment of parathyroid hormone-related protein (PTHrP)-mediated hypercalcemia of malignancy includes treating the malignancy, intravenous fluids, and anti-resorptive therapies such as zoledronic acid or denosumab. PTHrP-mediated hypercalcemia has been reported in benign conditions such as systemic lupus erythematous (SLE) and sarcoidosis and appears to be responsive to glucocorticoids. We report a case of PTHrP-induced hypercalcemia due to a malignancy-low grade fibromyxoid sarcoma-that responded to glucocorticoid treatment. This is the first report of glucocorticoids controlling PTHrP-mediated hypercalcemia of malignancy. Immunohistochemistry of the surgical pathology localized PTHrP staining to the vascular endothelial cells within the tumor. Further studies are needed to elucidate the mechanism of glucocorticoid action in the treatment of PTHrP-mediated hypercalcemia of malignancy.

Keywords: Case report; Fibromyxoid sarcoma; Glucocorticoids; Hypercalcemia; Parathyroid hormone-related protein (PTHrP).

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Endothelial Cells
  • Glucocorticoids / therapeutic use
  • Humans
  • Hypercalcemia* / drug therapy
  • Hypercalcemia* / etiology
  • Hypercalcemia* / metabolism
  • Parathyroid Hormone-Related Protein
  • Sarcoma*

Substances

  • Parathyroid Hormone-Related Protein
  • Glucocorticoids