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Review
. 2007 Jul;22(7):1042-6.
doi: 10.1007/s11606-007-0189-1. Epub 2007 Apr 19.

Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature

Kara Pepper  1 , Uraporn Jaowattana, Michael D Starsiak, Raghuueer Halkar, Kelly Hornaman, Wenli Wang, Priya Dayamani, Vin Tangpricha
Affiliations
Review

Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature

Kara Pepper et al. J Gen Intern Med. 2007 Jul.

Abstract

We report a case of a 62-year-old woman with renal cell carcinoma (RCC) presenting with a hypercalcemia-induced coma. A laboratory evaluation indicated nonparathyroid-mediated hypercalcemia with an initial serum calcium level of 18.6 mg/dL. Our patient's parathyroid hormone (PTH)-related peptide level was undetectable. Initial imaging was negative, but PET scan identified a mass in the upper pole of the left kidney. Our patient underwent partial nephrectomy, and the mass was identified as RCC on final pathology. After surgery, her hypercalcemia resolved and PTH returned to normal limits. This case report describes a patient with RCC with the unusual presentation of hypercalcemic coma. We review the differential diagnosis of malignant hypercalcemia and the evaluation of hypercalcemia occurring with RCC. This case illustrates the need to carefully review and interpret all available data, especially when conventional testing in the work-up of hypercalcemia is unrevealing.

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Figures

Figure 1
Figure 1
Abdominal CT and PET scan in our patient with hypercalcemia. Top left = CT axial, top right = PET axial, bottom left = CT coronal, bottom right = coronal PET, 1 = left kidney, 2 = right kidney, 3 = spleen, 4 = liver, 5 = abdominal aorta, 6 = stomach with oral contrast, 7 = thoracic vertebral body, circle = tumor. CT images demonstrate a 3.0 × 2.7-cm exophytic tumor emanating from the superior pole of the left kidney. On PET scan, fluorodeoxyglucose activity within the 2.7 × 2.3-cm tumor is equal to that of normal renal parenchyma.
Figure 2
Figure 2
Pathology from the kidney mass. Tissue from partial nephrectomy revealed renal cell carcinoma, clear cell type, Fuhrman grade 2, magnified at ×200 (above) and ×400 (below).
Figure 3
Figure 3
Calcium and PTH levels in our patient with renal cell carcinoma. The downward arrows represent days when a bisphosphonate was administered intravenously. The upward arrows represents the day surgery was performed.
See this image and copyright information in PMC

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