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1,25-Dihydroxyvitamin D-related hypercalcemia in lymphoma: Two case reports

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Summary

We report two patients with non-Hodgkin's lymphoma in whom hypercalcemia and elevated 1,25 dihydroxyvitamin D (1,25-(OH)2D3) levels developed in the absence of any lytic bone lesions. Hypercalcemia responded only transiently to glucocorticoids which were ill tolerated. Intravenous APD administration was needed to circumvene hypercalcemia. Humoral hypercalcemia of malignancy is discussed. Our cases confirm that hypercalcemia associated with elevated 1,25-(OH)2D3 may occur in malignant lymphoma.

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References

  1. Canellos, G.P. Hypercalcemia in malignant lymphoma and leukemia. Ann NY Acad Sci 1974, 230, 240–246.

    PubMed  Google Scholar 

  2. Rosenberg, S.A., Diamond, H.D., Jaslowitz, B., Craver, L.F. Lymphosarcoma: a review of 1269 cases. Medicine 1961, 40, 31–84.

    PubMed  Google Scholar 

  3. Walker, I.R. Lymphoma with hypercalcemia. Can Med Assoc J 1974, 111, 928–930.

    PubMed  Google Scholar 

  4. Shinoyama, M., Minato, K., Saito, H. et al. Comparison of clinical, morphologic and immunologic characteristics of adult T-cell leukemia-lymphoma. Jpn J Clin Oncol 1979, 9 (suppl.), 357–372.

    Google Scholar 

  5. Kinoshita, K., Kamihira, S., Ikeda, S., Yamada, Y., Muta, T., Kitamura, T., Ichimaru, M., Matsuo, T. Clinical, hematologic, and pathologic features of leukemic T-cell lymphoma. Cancer 1982, 50, 1554–1562.

    PubMed  Google Scholar 

  6. Jaffe, E.S., Blattner, W.A., Blayney, D.W., Bunn, P.A., Cossman, J., Robert-Guroff, M., Gallo, R.C. The pathologic spectrum of adult T-cell leukemia/ lymphoma in the United States. Am J Surg Pathol 1984, 8, 263–275.

    PubMed  Google Scholar 

  7. Mundy, G.R. Pathogenesis of hypercalcaemia of malignancy. Clin Endocrinol (Oxf), 1985, 23, 705–714.

    Google Scholar 

  8. Ralston, S.H. The pathogenesis of humoral hypercalcaemia of malignancy. Lancet 1987, ii, 1443–1446.

    Google Scholar 

  9. Breslau, N.A., McGuire, J.L., Zerwekh, J.E., Frenkel, E.P., Pak, C.Y.C. Hypercalcemia associated with increased serum calcitriol levels in three patients with lymphoma. Ann Intern Med 1984, 100, 1–7.

    PubMed  Google Scholar 

  10. Needle, M.A., Chandra, B. Hypercalcemia, Hodgkin's disease, and calcitriol. Ann Intern Med 1984, 100, 916.

    Google Scholar 

  11. Rosenthal, N., Insogna, K.L., Godsall, J.W., Smaldone, L., Waldron, J.A., Stewart, A.F. Elevations in circulating 1,25-dihydroxyvitamin D in three patients with lymphoma-associated hypercalcemia. J Clin Endocrinol Metab 1985, 60, 29–33.

    PubMed  Google Scholar 

  12. Zaloga, G.P., Eil, C., Medbery, C.A. Humoral hy- percalcemia in Hodgkin's disease. Arch Intern Med 1985, 145, 155–157.

    PubMed  Google Scholar 

  13. Davies, M., Hayes, M.E., Mawer, E.B., Lumb, G.A. Abnormal vitamin D metabolism in Hodgkin's lymphoma. Lancet 1985, i, 1186–1188.

    Google Scholar 

  14. Lambrecht, L., Boelaert, J., Louwagie, A., Criel, A., Daneels, R., Bouillon, R. Hypercalcaemia in Hodgkin's disease. Acta Clin Belg 1986, 41, 37–42.

    PubMed  Google Scholar 

  15. Adams, J.S., Fernandez, M., Gacad, M.A., Gill, P.S., Endres, D.B., Rasheed, S., Singer, F.R. Vitamin D metabolite-mediated hypercalcemia and hypercalciuria patients with AIDS — and non — AIDS — associated lymphoma. Blood 1989, 73, 235–239.

    PubMed  Google Scholar 

  16. Helikson, M.A., Havey, A.D., Zerwekh, J.E., Breslau, N.A., Gardner, D.W. Plasma-cell granuloma producing calcitriol and hypercalcemia. Ann Intern Med 1986, 105, 379–381.

    PubMed  Google Scholar 

  17. Mudde, A.H., van den Berg, H., Boshuis, P.G., Breedveld, F.C., Markusse, H.M., Kluin, P.M., Bijvoet, O.L.M., Papapoulos, S.E. Ectopic production of 1,25-dihydroxyvitamin D by B-cell lymphoma as a cause of hypercalcemia. Cancer 1987, 59, 1543–1546.

    PubMed  Google Scholar 

  18. De Nayer, P., Thalasso, M., Beckers, C. Assay of 25-OH vitamin D3 in: Radioimmunoassay and Related Procedures in Medicine 1977. Vol II. Vienna, International Atomic Energy Agency, 199–209, 1978.

    Google Scholar 

  19. Reinhardt, T.A., Horst, R.L., Orf, J.W., Hollis, B.W. A microassay for 1,25-dihydroxyvitamin D not requiring high performance liquid chromatography: application to clinical studies. J Clin Endocrinol Metab 1984, 58, 91–98.

    PubMed  Google Scholar 

  20. Huaux, J.P., Maldague, B., Deronde, T., Nagant de Deuxchaisnes, C., De Plaen, J.L. Toxicité osseuse de la vitamine A. A propos d'une observation. Louvain Med 1984, 103, 327–340.

    Google Scholar 

  21. Stern, P.H., De Olazabal, J., Bell, N.H. Evidence for abnormal regulation of circulating α, 25-dihydroxyvitamin D in patients with sacroidosis and normal calcium metabolism. J Clin Invest 1980, 66, 852–855.

    PubMed  Google Scholar 

  22. Bell, N.H., Epstein, S., Shary, J., Greene, V., Oexmann, M.J., Shaw, S. Evidence of a probable role for 25-Hydroxyvitamin D in the regulation of human calcium metabolism. J Bone Miner Res 1988, 3, 489–495.

    PubMed  Google Scholar 

  23. Sandler, L.M., Winearls, CG, Fraher, L.J., Clemens, T.L., Smith, R., O'Riordan, J.L.H. Studies of the hypercalcaemia of sarcoidosis: effect of steroids and exogenous vitamin D3 on the circulating concentrations of 1,25-Dihydroxyvitamin D3. Q J Med 1984, 53, 165–180.

    PubMed  Google Scholar 

  24. Ralston, S.H., Cowan, R.A., Robertson, A.G., Gardner, M.D., Boyle, I.T. Circulating vitamin D metabolites and hypercalcaemia of malignancy. Acta Endocrinol 1984, 106, 556–563.

    PubMed  Google Scholar 

  25. Ralston, S.H., Fogelman, I., Gardiner, M.D., Boyle, I.T. Relative contribution of humoral and metastatic factors to the pathogenesis of hypercalcaemia in malignancy. Br Med J 1984, 288, 1405–1408.

    Google Scholar 

  26. Raisz, L.G., Trummel, C.L., Holick, M.F., DeLuca, H.F. 1,25-dihydroxycholecalciferol: a potent stimulator of bone resorption in tissue culture. Science 1972, 175, 768–769.

    PubMed  Google Scholar 

  27. Mundy, G.R. Hypercalcemia of malignancy revisited. J Clin Invest 1988, 82, 1–6.

    PubMed  Google Scholar 

  28. Burtis, W.J., Wu, T.L., Insogna, K.L., Stewart, A.F. Humoral hypercalcemia of malignancy. Ann Intern Med 1988, 108, 454–457.

    PubMed  Google Scholar 

  29. Mundy, G.R., Ibbotson, K.J., D'Souza, S.M. Tumor products and the hypercalcemia of malignancy. J Clin Invest 1985, 76, 391–394.

    PubMed  Google Scholar 

  30. DeRemee, R.A., Banks, P.M. Non-Hodgkin's lymphoma associated with hypercalcemia and increased activity of serum angiotensin-converting enzyme. Mayo Clin Proc 1986, 61, 714–718.

    PubMed  Google Scholar 

  31. Chesney, R.W., Hamstra, A.J., DeLuca, H.F., Horowitz, S., Gilbert, E.F., Hong, R., Borcherding, W. Elevated serum 1,25-dihydroxyvitamin D concentrations in the hypercalcemia of sarcoidosis: correction by glucocorticoid therapy. J Pediatr 1981, 98, 919–922.

    PubMed  Google Scholar 

  32. Huaux, J.P., Noël, H., Bastien, P., Doyen, C., Nagant de Deuxchaisnes, C. Les lésions osseuses de la leucémie à tricholeucocytes. Quelques considérations thérapeutiques. A propos d'une observation. Acta Clin Belg 1984, 39, 339–351.

    PubMed  Google Scholar 

  33. Harinck, H.I.J, Bijvoet, O.L.M, Plantingh, A.S.T., Body, J.J., Elte, J.W., Sleeboom, H.P., Wildiers, J., Neijt, J.P. Role of bone and kidney in tumor — induced hypercalcemia and its treatment with bisphosphonate and sodium chloride. Am J Med 1987, 82, 1133–1142.

    PubMed  Google Scholar 

  34. Noël, H., Helbron, D., Lennert, K. Epithelioid cellular lymphogranulomatosis (lymphoepithelioid cell lymphoma): histologic and clinical observations. Eds: van den Tweel, J.G., Taylor, C.R., Bosman, F.T. In: Malignant Lymphoproliferative Diseases. Leiden University Press, The Hague 1980, 433–445.

    Google Scholar 

  35. Barbour, G.L., Coburn, J.W., Slatopolsky, E., Norman, A.W., Horst, R.L. Hypercalcemia in an anephric patient with sarcoidosis: evidence for extrarenal generation of 1,25-dihydroxyvitamin D. N Engl J Med 1981, 305, 440–443.

    PubMed  Google Scholar 

  36. Mason, R.S., Frankel, T., Chan, Y-L., Lissner, D., Posen, S. Vitamin D conversion by sarcoid lymph node homogenate. Ann Intern Med 1984, 100, 59–61.

    PubMed  Google Scholar 

  37. Adams, J.S., Sharma, O.P., Gacad, M.A., Singer, F.R. Metabolism of 25-hydroxyvitamin D3 by cultured pulmonary alveolar macrophages in sarcoidosis. J Clin Invest 1983, 72, 1856–1860.

    PubMed  Google Scholar 

  38. Choe, J.K., Hyun, B.H., Salazar, G.H., Ashton, J.K., Sung, C. Epithelioid granulomas of the bone marrow in non-Hodgkin's lymphoproliferative malignancies. Am J Clin Pathol 1984, 81, 19–24.

    PubMed  Google Scholar 

  39. Dodd, R.C., Winkler, C.F., Williams, M.E., Bunn, P.A., Gray, T.K. Calcitriol levels in hypercalcemic patients with adult T-cell lymphoma. Arch Intern Med 1986, 146, 1971–1972.

    PubMed  Google Scholar 

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Devogelaer, J.P., Lambert, M., Boland, B. et al. 1,25-Dihydroxyvitamin D-related hypercalcemia in lymphoma: Two case reports. Clin Rheumatol 9, 404–410 (1990). https://doi.org/10.1007/BF02114405

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