Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 10, 2016; 7(2): 265-269
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.265
Gallbladder adenocarcinoma and paraneoplastic parathyroid hormone mediated hypercalcemia
Meera Yogarajah, Bhradeev Sivasambu, Zewge Shiferaw-Deribe
Meera Yogarajah, Bhradeev Sivasambu, Zewge Shiferaw-Deribe, Department of Medicine, Interfaith Medical Center, Brooklyn, NY 11213, United States
Author contributions: Yogarajah M, Sivasambu B and Shiferaw-Deribe Z made substantial contributions to the conception, drafting and revision of the manuscript; Yogarajah M, Sivasambu B and Shiferaw-Deribe Z approve the version submitted and are in agreement to be accountable for all aspects of the work.
Institutional review board statement: This case report was exempt from the standards of Interfaith Medical center Institutional review board.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None of the authors has any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Meera Yogarajah, MD, Department of Medicine, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY 11213, United States.
Telephone: +1-732-7238474
Received: September 2, 2015
Peer-review started: September 8, 2015
First decision: October 16, 2015
Revised: October 19, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: April 10, 2016

Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells. We present a case of 86-year-old female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels. Imaging with technetium 99 m sestamibi scintigraphy with dual phase, subtraction thyroid scan (dual isotope scintigraphy), magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites. We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing. We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.

Keywords: Paraneoplastic hypercalcemia, Gallbladder adenocarcinoma, Hypercalcemia, Hyperparathyroidism, Ectopic parathyroid secretion

Core tip: Gallbladder carcinoma rarely can cause hypercalcemia with very few reported cases but they were all due to parathyroid hormone (PTH) related peptide. We present the first case of metastatic gallbladder adenocarcinoma with hypercalcemia due to ectopic PTH secretion from tumor cells. PTH mediated hypercalcemia is not exclusively primary hyperparathyroidism and awareness of this rare paraneoplastic presentation will prevent unnecessary parathyroid surgeries. Moreover this case prompts physicians to look for another ectopic source in the absence of parathyroid lesion which would facilitate early diagnosis of an underlying malignancy.