{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:01:31Z","timestamp":1774278091867,"version":"3.50.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100014718","name":"Innovative Research Group Project of the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["2020HXFH034"],"award-info":[{"award-number":["2020HXFH034"]}],"id":[{"id":"10.13039\/100014718","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Hypercalcemia associated with acromegaly is mostly parathyroid hormone (PTH)-dependent, being caused by parathyroid hyperplasia or adenoma, which are common in individuals with multiple endocrine adenomatosis-1 (MEN-1). The rare occurrence of non-PTH-dependent hypercalcemia associated with acromegaly is attributable to complex factors involving increased intestinal calcium absorption, enhanced bone calcium release, and reduced urinary calcium elimination. Although patients with acromegaly often have mild hyperphosphatemia and hypercalciuria, clinically significant hypercalcemia is extremely rare.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>Here we present a case of non-PTH-dependent hypercalcemia associated with a growth hormone- (GH) and prolactin- (PRL) co-secreting pituitary macroadenoma. A 37-year-old Chinese man presented with a 6-year history of increasing ring and shoe sizes and was referred to the West China Hospital of Sichuan University for treatment of acromegaly. Pituitary magnetic resonance imaging (MRI) showed a 2.0\u2009\u00d7\u20091.7\u2009\u00d7\u20091.9\u00a0cm macroadenoma. Laboratory examinations revealed high serum concentrations of GH and PRL with mild hypercalcemia, hyperphosphatemia, hypercalciuria, inhibited PTH concentration, and increased bone turnover markers. Administration of cabergoline together with somatostatin resulted in sharp decreases in his GH, PRL, and serum and urinary calcium concentrations. These values were further reduced 5 months later and his PTH and bone turnover markers gradually returned to within the normal range.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Mild hyperphosphatemia and hypercalciuria are common in individuals with acromegaly and deserve attention because they may contribute to osteoporosis and urolithiasis. However, overt hypercalcemia is rare in such individuals. It is usually attributable to a coexisting parathyroid hyperplasia or adenoma, rarely being non-PTH-dependent. In such cases, the hypercalcemia is attributable to excessive PRL and hypogonadism and reverses with remission of acromegaly.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-021-00756-z","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T12:01:23Z","timestamp":1620043283000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Acromegaly and non\u2010parathyroid hormone\u2010dependent hypercalcemia: a case report and literature review"],"prefix":"10.1186","volume":"21","author":[{"given":"Shaomin","family":"Shi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yerong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianwei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"issue":"Suppl 1","key":"756_CR1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s11102-010-0286-8","volume":"15","author":"R Shah","year":"2012","unstructured":"Shah R, Licata A, Oyesiku NM, Ioachimescu AG. Acromegaly as a cause of 1,25-dihydroxyvitamin D-dependent hypercalcemia: case reports and review of the literature. Pituitary. 2012;15(Suppl 1):17\u201322.","journal-title":"Pituitary"},{"key":"756_CR2","doi-asserted-by":"publisher","first-page":"307","DOI":"10.2169\/internalmedicine.44.307","volume":"44","author":"M Ueda","year":"2005","unstructured":"Ueda M, Inaba M, Tahara H, Imanishi Y, Goto H, Nishizawa Y. Hypercalcemia in a patient with primary hyperparathyroidism and acromegaly: distinct roles of growth hormone and parathyroid hormone in the development of hypercalcemia. Intern Med (Tokyo Japan). 2005;44:307\u201310.","journal-title":"Intern Med (Tokyo Japan)"},{"key":"756_CR3","doi-asserted-by":"crossref","unstructured":"Thakker RV. Multiple endocrine neoplasia type 1 (MEN1). Best practice & research Clinical endocrinology & metabolism. 2010;24:355 \u2013 70.","DOI":"10.1016\/j.beem.2010.07.003"},{"key":"756_CR4","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.4158\/EP13228.CR","volume":"20","author":"P Manroa","year":"2014","unstructured":"Manroa P, Kannan S, Hatipoglu B, Licata A. Hypercalcemia and acromegaly\u2013clarifying the connections. A case report and review of the literature. Endocrine practice. 2014;20:e86\u201390.","journal-title":"Endocrine practice"},{"key":"756_CR5","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1159\/000491040","volume":"51","author":"D Goltzman","year":"2019","unstructured":"Goltzman D. Nonparathyroid Hypercalcemia. Front Horm Res. 2019;51:77\u201390.","journal-title":"Front Horm Res"},{"key":"756_CR6","doi-asserted-by":"publisher","first-page":"2416","DOI":"10.1210\/jc.2016-3693","volume":"102","author":"T Constantin","year":"2017","unstructured":"Constantin T, Tangpricha V, Shah R, et al. Calcium and Bone Turnover Markers in Acromegaly: A Prospective, Controlled Study. J Clin Endocrinol Metab. 2017;102:2416\u201324.","journal-title":"J Clin Endocrinol Metab"},{"key":"756_CR7","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1046\/j.1365-2796.2000.00769.x","volume":"248","author":"MM Hermans","year":"2000","unstructured":"Hermans MM, Lips CJ, Bravenboer B. Growth hormone overproduction in a patient with multiple endocrine neoplasia type I. Journal of internal medicine. 2000;248:525\u201330.","journal-title":"Journal of internal medicine"},{"key":"756_CR8","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1210\/endo-98-5-1289","volume":"98","author":"SR Lancer","year":"1976","unstructured":"Lancer SR, Bowser EN, Hargis GK. The effect of growth hormone on parathyroid function in rats. Endocrinology. 1976;98:1289\u201393.","journal-title":"Endocrinology"},{"key":"756_CR9","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1530\/acta.0.0960444","volume":"96","author":"B Lund","year":"1981","unstructured":"Lund B, Eskildsen PC, Lund B, Norman AW, Sorensen OH. Calcium and vitamin D metabolism in acromegaly. Acta endocrinologica. 1981;96:444\u201350.","journal-title":"Acta endocrinologica"},{"key":"756_CR10","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1111\/j.1365-2265.1973.tb00418.x","volume":"2","author":"G Sigurdsson","year":"1973","unstructured":"Sigurdsson G, Nunziata V, Reiner M, Nadarajah A, Joplin GF. Calcium absorption and excretion in the gut in acromegaly. Clin Endocrinol. 1973;2:187\u201392.","journal-title":"Clin Endocrinol"},{"key":"756_CR11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1210\/jcem-61-1-7","volume":"61","author":"S Takamoto","year":"1985","unstructured":"Takamoto S, Tsuchiya H, Onishi T, et al. Changes in calcium homeostasis in acromegaly treated by pituitary adenomectomy. J Clin Endocrinol Metab. 1985;61:7\u201311.","journal-title":"J Clin Endocrinol Metab"},{"key":"756_CR12","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1136\/bmj.4.5634.797","volume":"4","author":"A Nadarajah","year":"1968","unstructured":"Nadarajah A, Hartog M, Redfern B, et al. Calcium metabolism in acromegaly. British medical journal. 1968;4:797\u2013801.","journal-title":"British medical journal"},{"key":"756_CR13","first-page":"1452","volume":"76","author":"S Ezzat","year":"1993","unstructured":"Ezzat S, Melmed S, Endres D, Eyre DR, Singer FR. Biochemical assessment of bone formation and resorption in acromegaly. J Clin Endocrinol Metab. 1993;76:1452\u20137.","journal-title":"J Clin Endocrinol Metab"},{"key":"756_CR14","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/0090-4295(85)90118-9","volume":"26","author":"A Pines","year":"1985","unstructured":"Pines A, Olchovsky D. Urolithiasis in acromegaly. Urology. 1985;26:240\u20132.","journal-title":"Urology"},{"key":"756_CR15","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1530\/acta.0.0940459","volume":"94","author":"J Halse","year":"1980","unstructured":"Halse J, Haugen HN. Calcium and phosphate metabolism in acromegaly. Acta endocrinologica. 1980;94:459\u201367.","journal-title":"Acta endocrinologica"},{"key":"756_CR16","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1530\/acta.0.1040153","volume":"104","author":"JW Bijlsma","year":"1983","unstructured":"Bijlsma JW, Nortier JW, Duursma SA, Croughs RJ, Bosch R, Thijssen JH. Changes in bone metabolism during treatment of acromegaly. Acta endocrinologica. 1983;104:153\u20139.","journal-title":"Acta endocrinologica"},{"key":"756_CR17","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1016\/0024-3205(76)90083-7","volume":"19","author":"E Spanos","year":"1976","unstructured":"Spanos E, Pike JW, Haussler MR, et al. Circulating 1alpha,25-dihydroxyvitamin D in the chicken: enhancement by injection of prolactin and during egg laying. Life sciences. 1976;19:1751\u20136.","journal-title":"Life sciences"},{"key":"756_CR18","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1038\/267630a0","volume":"267","author":"A Boass","year":"1977","unstructured":"Boass A, Toverud SU, McCain TA, Pike JW, Haussler MR. Elevated serum levels of 1alpha, 25-dihydroxycholecalciferol in lactating rats. Nature. 1977;267:630\u20132.","journal-title":"Nature"},{"key":"756_CR19","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1210\/jc.2014-2937","volume":"100","author":"G Mazziotti","year":"2015","unstructured":"Mazziotti G, Biagioli E, Maffezzoni F, et al. Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis. 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Curr Opin Endocrinol Diabetes Obes. 2014;21:476\u201382.","journal-title":"Curr Opin Endocrinol Diabetes Obes"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-021-00756-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-021-00756-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-021-00756-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T23:11:52Z","timestamp":1626822712000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-021-00756-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["756"],"URL":"https:\/\/doi.org\/10.1186\/s12902-021-00756-z","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,1]]},"assertion":[{"value":"2 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The work described has been carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). This case study was approved by the ethics committee of West China Hospital of Sichuan University Biomedical Research Ethics Committee and the consent to participate was waived. The ethics approval number is 2020\u2009\u2212\u2009623.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patient gave written informed consent for publication of his clinical details.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"90"}}