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Pediatric Nephrology

, Volume 26, Issue 5, pp 799–803 | Cite as

Parathyroid-hormone-related protein-mediated hypercalcemia in benign congenital mesoblastic nephroma

  • Tarak Srivastava
  • Alexander Kats
  • T. John Martin
  • Suelli Pompolo
  • Uri S. Alon
Brief Report

Abstract

Parathyroid hormone-related protein (PTHrP) mediated hypercalcemia of malignancy is rare in children, and even more so in the setting of a benign tumor. We report two infants with PTHrP-mediated hypercalcemia secondary to congenital mesoblastic nephroma and their outcome after removal of the benign tumor. Pre-operatively hypercalcemia was corrected with saline hydration, furosemide, calcitonin and/ or pamidronate. Following resection of the tumor serum PTHrP normalized. Immunohistochemical staining of tumor cells was positive for PTHrP. Post-operatively the infants developed elevated serum parathyroid hormone with low- normal serum Ca and P, and undetectable urinary Ca and P, probably due to their movement into bone. Children needed treatment with calcitriol, Ca and P supplementation for 6-12 weeks until PTH normalized and urinary Ca and P were detected, suggesting bone replenishment. We conclude that benign congenital mesoblastic nephroma can secrete PTHrP that can cause severe hypercalcemia; and following excision one should anticipate the development of a transient modified “hungry bone”-like condition requiring Ca, P and calcitriol therapy for several weeks accompanied by careful monitoring of mineral homeostasis.

Keywords

PTHrP Congenital mesoblastic nephroma Hypercalcemia Hungry bone 

Notes

Acknowledgement

The study was supported by the Sam and Helen Kaplan Research Fund in Pediatric Nephrology and Eric McClure Research Fund in Pediatric Bone and Mineral Disorders.

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Copyright information

© IPNA 2010

Authors and Affiliations

  • Tarak Srivastava
    • 1
  • Alexander Kats
    • 2
  • T. John Martin
    • 3
  • Suelli Pompolo
    • 3
  • Uri S. Alon
    • 1
  1. 1.Section of NephrologyChildren’s Mercy Hospital and University of Missouri at Kansas CityKansas CityUSA
  2. 2.Department of Pathology and Laboratory MedicineChildren’s Mercy Hospital and University of Missouri at Kansas CityKansas CityUSA
  3. 3.Bone Cell Biology and Disease UnitSt. Vincent’s Institute, The University of MelbourneFitzroyAustralia

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