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Occult Pulmonary Neuroendocrine Tumor Causing Severe Hyperparathyroidism: Diagnostic Challenges and Clinical Outcomes

Yazdian, Aaron
; 
Minuk, Jeffrey
; 
Hemenway, Gregory
; 
Upadhyaya, Neelam
; 
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Genre
Journal article
Date
2022-09-15
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Committee member
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Temple University. Hospital
Department
Medicine
Subject
Ectopic PTH secretion
 Neuroendocrine tumor
 Hyperparathyroidism
 Osteitis
 Fibrosa cystica
 Hungry bone syndrome
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http://hdl.handle.net/20.500.12613/9744
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YazdianEtAl-JournalArticle-2022-09.pdf
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http://dx.doi.org/10.1016/j.aace.2022.06.002
Abstract
Background/Objective: Ectopic tumoral production of parathyroid hormone (PTH) is rare. The incidence of hyperparathyroidism and osteitis fibrosa cystica (OFC) secondary to ectopic PTH secretion has only been reported in case reports, although infrequent. Case Report: We report a case of a well-differentiated pulmonary neuroendocrine tumor (NET) producing PTH that presented with severe hypercalcemia and OFC. Surgical removal of the pulmonary tumor resulted in resolution of hypercalcemia. Immunocytochemical analysis of the tumor tissue revealed PTH-positive staining. Recovery was complicated by severe hypocalcemia due to hungry bone syndrome. Discussion: To the best of our knowledge, this is the first documented case of a pulmonary NET causing OFC via PTH. We further describe the successful identification and resection of a rare NET and restoration of calcium homeostasis with aggressive calcium and vitamin D repletion. Conclusion: Although a rare cause of severe hypercalcemia and OFC, ectopic tumoral production of PTH must be considered in the differential diagnosis. Furthermore, resection of these tumors secreting PTH can lead to a protracted and severe high risk of hungry bone syndrome, which requires aggressive treatment to maintain calcium homeostasis.
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Citation
Aaron Yazdian, Jeffrey Minuk, Gregory Hemenway, Neelam Upadhyaya, Cherie Lisa Vaz, Occult Pulmonary Neuroendocrine Tumor Causing Severe Hyperparathyroidism: Diagnostic Challenges and Clinical Outcomes, AACE Clinical Case Reports, Volume 8, Issue 5, 2022, Pages 210-216, ISSN 2376-0605, https://doi.org/10.1016/j.aace.2022.06.002.
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Elsevier
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AACE Clinical Case Reports, Vol. 8, Iss. 5
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