Parathyroid-hormone-related protein-mediated hypercalcemia in benign congenital mesoblastic nephroma
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Tarak Srivastava & Alexander Kats & T. John Martin & Suelli Pompolo & Uri S. Alon
- چاپ و سال / کشور: 2011
Description
Parathyroid hormone-related protein (PTHrP) mediated hypercalcemia of malignancy is rare in children, and even more so in the setting of a benign tumor. We report two infants with PTHrP-mediated hypercalcemia secondary to congenital mesoblastic nephroma and their outcome after removal of the benign tumor. Pre-operatively hypercalcemia was corrected with saline hydration, furosemide, calcitonin and/ or pamidronate. Following resection of the tumor serum PTHrP normalized. Immunohistochemical staining of tumor cells was positive for PTHrP. Postoperatively the infants developed elevated serum parathyroid hormone with low- normal serum Ca and P, and undetectable urinary Ca and P, probably due to their movement into bone. Children needed treatment with calcitriol, Ca and P supplementation for 6-12 weeks until PTH normalized and urinary Ca and P were detected, suggesting bone replenishment. We conclude that benign congenital mesoblastic nephroma can secrete PTHrP that can cause severe hypercalcemia; and following excision one should anticipate the development of a transient modified “hungry bone”-like condition requiring Ca, P and calcitriol therapy for several weeks accompanied by careful monitoring of mineral homeostasis.
Pediatr Nephrol (2011) 26:799–803 DOI 10.1007/s00467-010-1728-2 Received: 25 August 2010 / Revised: 21 November 2010 / Accepted: 23 November 2010 / Published online: 15 December 2010
