Journal Information
Vol. 37. Issue. 1.January - February 2017
Pages 1-114
Vol. 37. Issue. 1.January - February 2017
Pages 1-114
Letter to the Editor
DOI: 10.1016/j.nefroe.2017.01.023
Open Access
Hypercalcemia and hypophosphatemia in a 11 years old girl with ovarian tumour
Hipercalcemia e hipofosforemia en niña con tumour ovárico
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Mercedes Ubetagoyena Arrietaa,
Corresponding author
, Jorge Martinez Sainz de Juberaa, Nagore García de Andoin Barandiaranb, José Javier Úriz Monautb, Sheila López Cuestaa, Ana Domínguez Castellsb
a Sección de Nefrología Pediátrica, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
b Servicio de Oncología Pediátrica, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
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Table 1. Biochemical blood and urine values prior to tumour removal and at days 6, 30 and 60 after surgery.
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Dear Editor,

The most common cause of hypercalcaemia in patients with non-metastatic solid tumours is the secretion of parathyroid hormone-related (PTHr) protein.1

The patient is an 11-year-old female with no history of interest, to be evaluated for an abdominal mass. Upon arrival the patient showed high serum creatinine, hypercalcaemia and hypophosphatemia (Table 1). The baseline renal function test also showed hypercalciuria and hyperphosphaturia. CT scan showed a large intra-abdominal mass. A complete resection of the tumour was performed. An anatomopathological study revealed the presence of an ovarian granulosa cell tumour.

Table 1.

Biochemical blood and urine values prior to tumour removal and at days 6, 30 and 60 after surgery.

  Pre-operative  Six days after surgery  Thirty days after surgery  Sixty days after surgery 
Blood creatinine (mg/dl)  1.13  0.75  0.66  0.64 
Blood-ionised calcium (mMol/l)  1.66  1.18  1.27  1.22 
Blood phosphate (mg/dl)  2.6mgr/dl  2.8mgr/dl  5.2  5.4 
PTH intact (pg/ml)  2.7  44  –  – 
PTHra (pmol/l)  10.8  <1.1  –  – 
Vitamin D (ng/ml)  30  –  –  – 
Calcitonin (pg/ml)  10.4  –  –  – 
Urine Ca/Cr ratio  1.4  0.46  0.09  0.07 
CEIa  1.59  0.34  0.06  0.05 
Calciuria (mg/kg/24h)  15  7.43  1.61  1.26 
TRPa  32  96  94  90 
TP/GFRa  0.85  2.71  4.88  4.82 
Phosphaturia (mg/24h/1.73m2954  110  427  880 

CEI: calcium excretion index; PTHr: parathyroid hormone-related protein; TP/GFR: phosphate per 100ml of glomerular filtration rate; TRP: tubular reabsorption of phosphate.

a

Source: Santos and García-Nieto.9

Clinical course was favourable. In the follow-up, one week after removal of the tumour, blood calcium levels normalised but urinary calcium remained high. The hypophosphataemia persisted, despite greater renal reabsorption of phosphate. After one month, all blood and urine biochemical parameters were within the normal range (Table 1).

Hypercalcaemia due to hypersecretion of PTHr by malignant tumours is an exceptional finding at paediatric age.2,3 Parathyroid hormone (PTH) and PTHr have shown similar effects in the renal handling of calcium and phosphate.4–7 They release calcium from bone and promote the renal reabsorption of calcium in the distal nephron. They also produce hyperphosphaturia by decreasing the tubular reabsorption of phosphate that may result in hypophosphataemia. However, patients with hyperparathyroidism may present with hypercalciuria.8 The elevated calcaemia in our patient is related to high levels of PTHr. Significantly, hypercalciuria persisted after excision of the tumour and normalisation of calcaemia levels.

Another remarkable finding was the presence of hypophosphataemia, which became significant. The hypophosphataemia coincided with a situation of renal phosphate loss, evidenced by low levels of TRP and TP/GFR, indicating that the hypophosphataemia was of renal origin.

In conclusion, we present a case of PTHr-mediated hypercalcaemia secondary to an ovarian tumour in an age group that is rarely affected by this condition. In addition to transient renal failure, the biochemical data show hypercalcaemia accompanied by hypercalciuria. The hypophosphataemia is secondary to an excessive loss of phosphate through the kidney.

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Serun parathyroid hormona-related protein concentrations in patients with hematologic malignancies or solid tumors.
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Juvenile granulosa cell tumor of the ovary associated with hypercalcemia.
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Parathyroid hormone-related protein-(1-36) stimulates renal tubular calcium reabsorption in normal human volunteers: Implications for the pathogenesis of humoral hypercalcemia of malignancy.
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Nefrología Pediátrica, 2.ª edición, pp. 39-49

Please cite this article as: Ubetagoyena Arrieta M, Martinez Sainz de Jubera J, García de Andoin Barandiaran N, Úriz Monaut JJ, López Cuesta S, Domínguez Castells A. Hipercalcemia e hipofosforemia en niña con tumour ovárico. Nefrologia. 2017;37:100–101.

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