{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:53Z","timestamp":1784557073940,"version":"3.55.0"},"reference-count":8,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"\n Summary<\/jats:title>\n A 77-year-old female patient with a history of treated breast cancer and a recently diagnosed laryngeal cancer presented with severe hypercalcaemia associated with suppressed parathyroid hormone (PTH) levels. Her initial investigations included 25-hydroxy vitamin D levels, short synacthen test, bone scan, myeloma screen and thyroid function tests which were within normality. A computerised tomography (CT) scan showed some right lung apical fibrotic changes. Her PTH-related peptide (PTHrP) was normal and sarcoidosis was also excluded. Her previous and current malignancies were thought to be unlikely behind her hypercalcaemia. Her 1,25-dihydroxy vitamin D (calcitriol) levels were found to be elevated. Her hypercalcaemia was initially managed with intravenous fluids and intermittent bisphosphonates infusions which would transiently reduce her calcium levels. Steroid treatment was initiated which improved her hypercalcaemia; however, the calcium levels rebounded on tapering the steroids down, a pre-requisite prior to a positron emission computerised tomography (PET-CT) scan to determine the source of the excess calcitriol production. This was cancelled following an emergency admission with marked hypercalcaemia and acute renal and liver injury. A contemporary CT scan showed a right apical lung mass with hepatic lesions suggestive of a disseminated lung primary. The histology obtained from a liver biopsy was compatible with metastatic small-cell lung carcinoma. Unfortunately, her clinical condition deteriorated further and she did not survive. To the best of our knowledge, this is the first report in the literature describing calcitriol-mediated hypercalcaemia due to a small-cell lung cancer.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Paraneoplastic hypercalcaemia may manifest even without overt detection of the primary cancer.<\/jats:p>\n <\/jats:list-item>\n \n The workup for paraneoplastic hypercalcaemia should be meticulous.<\/jats:p>\n <\/jats:list-item>\n \n Both bisphosphonates and steroids are useful in the initial management of calcitriol-mediated hypercalcaemia, but the definitive management is the treatment of the cause.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-22-0371","type":"journal-article","created":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T17:30:52Z","timestamp":1687455052000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["An uncanny case of paraneoplastic calcitriol mediated hypercalcaemia"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3516-9992","authenticated-orcid":true,"given":"Preet Mukesh","family":"Shah","sequence":"first","affiliation":[{"name":"St James\u2019s University Hospital, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saadia","family":"Saeed","sequence":"additional","affiliation":[{"name":"St James\u2019s University Hospital, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3396-6266","authenticated-orcid":true,"given":"Susana","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Bradford Royal Infirmary, Bradford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"New England Journal of Medicine","first-page":"1443","article-title":"Cancer-associated hypercalcemia","volume":"386","author":"Guise","year":"2022","unstructured":"Guise TA & Wysolmerski JJ. Cancer-associated hypercalcemia. New England Journal of Medicine. SolomonCG, Ed. 20223861443\u20131451. (https:\/\/doi.org\/10.1056\/NEJMcp2113128)"},{"key":"bib2","series-title":"Case Reports in Pulmonology","first-page":"2475725","article-title":"Successful treatment for hypercalcemia due to cosecretion of parathyroid hormone-related protein and 1,25-dihydroxyvitamin d 3 in non-small-cell lung cancer: a case report and literature review","volume":"2020","author":"Ogawa","year":"2020","unstructured":"Ogawa TMiyata JFukunaga KKawana A & Inoue T. Successful treatment for hypercalcemia due to cosecretion of parathyroid hormone-related protein and 1,25-dihydroxyvitamin d 3 in non-small-cell lung cancer: a case report and literature review. Case Reports in Pulmonology202020202475725. (https:\/\/doi.org\/10.1155\/2020\/2475725)"},{"key":"bib3","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"4023","article-title":"Calcitriol-mediated hypercalcemia: causes and course in 101 patients","volume":"98","author":"Donovan","year":"2013","unstructured":"Donovan PJSundac LPretorius CJd\u2019Emden MC & McLeod DSA. Calcitriol-mediated hypercalcemia: causes and course in 101 patients. Journal of Clinical Endocrinology and Metabolism2013984023\u20134029. (https:\/\/doi.org\/10.1210\/jc.2013-2016)"},{"key":"bib4","series-title":"Case Reports in Oncological Medicine","first-page":"2583217","article-title":"Hypercalcemia in lung cancer due to simultaneously elevated pthrp and ectopic calcitriol production: first case report","volume":"2017","author":"Nemr","year":"2017","unstructured":"Nemr SAlluri SSundaramurthy DLandry D & Braden G. Hypercalcemia in lung cancer due to simultaneously elevated pthrp and ectopic calcitriol production: first case report. Case Reports in Oncological Medicine201720172583217. (https:\/\/doi.org\/10.1155\/2017\/2583217)"},{"key":"bib5","series-title":"European Journal of Endocrinology","first-page":"29","article-title":"Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders: a case series","volume":"178","author":"Koldkj\u00e6r S\u00f8lling","year":"2018","unstructured":"Koldkj\u00e6r S\u00f8lling ASTougaard BGHarsl\u00f8f TLangdahl BBrockstedt HKByg KEIvarsen PYstr\u00f8m MFHIsaksson GLHansen MSS, Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders: a case series. European Journal of Endocrinology201817829\u201337. (https:\/\/doi.org\/10.1530\/eje-18-0051)"},{"key":"bib6","series-title":"Journal of Clinical Endocrinology and Metabolism","article-title":"Calcitriol elevation is associated with a higher risk of refractory hypercalcemia of malignancy in solid tumors","volume":"105","author":"Chukir","year":"2020","unstructured":"Chukir TLiu YHoffman KBilezikian JP & Farooki A. Calcitriol elevation is associated with a higher risk of refractory hypercalcemia of malignancy in solid tumors. Journal of Clinical Endocrinology and Metabolism2020105 e1115\u2013e1123. (https:\/\/doi.org\/10.1210\/clinem\/dgz278)"},{"key":"bib7","series-title":"BMC Urology","article-title":"Calcitriol-mediated hypercalcemia as an immune-related adverse event in a patient receiving nivolumab and ipilimumab for metastatic renal cell carcinoma, case report","volume":"21","author":"Johnson","year":"2021","unstructured":"Johnson KIssa MParikh AMonk PYin MMortazavi A & Yang Y. Calcitriol-mediated hypercalcemia as an immune-related adverse event in a patient receiving nivolumab and ipilimumab for metastatic renal cell carcinoma, case report. BMC Urology202121 51. (https:\/\/doi.org\/10.1186\/s12894-021-00825-4)"},{"key":"bib8","series-title":"Clinical Endocrinology","first-page":"531","article-title":"Vitamin D intoxication causes hypercalcaemia by increased bone resorption which responds to pamidronate","volume":"43","author":"Selby","year":"1995","unstructured":"Selby PLDavies MMarks JS & Mawer EB. Vitamin D intoxication causes hypercalcaemia by increased bone resorption which responds to pamidronate. Clinical Endocrinology199543531\u2013536. (https:\/\/doi.org\/10.1111\/j.1365-2265.1995.tb02916.x)"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2023\/2\/EDM22-0371.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2023\/2\/EDM22-0371.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2023\/2\/EDM22-0371.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:06Z","timestamp":1784555286000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,1]]},"references-count":8,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1530\/edm-22-0371","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,1]]}}}