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Case Reports in Endocrinology
Volume 2013, Article ID 470890, 7 pages
Case Report

Hypercalcemia in Upper Urinary Tract Urothelial Carcinoma: A Case Report and Literature Review

1Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, The University of Michigan, Brehm Tower Room 5107, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105-1912, USA
2Department of Pathology, The University of Michigan, 1500 E. Medical Center Drive, Room 2G332 UH/Box 0054, Ann Arbor, MI 48109-0054, USA
3Department of Urology, The University of Michigan, Building 16, 1st Floor, Room 108E, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, USA
4Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, The University of Michigan, Domino’s Farms, Lobby C, Suite 1300, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0451, USA

Received 15 December 2012; Accepted 8 January 2013

Academic Editors: C. Capella, W. V. Moore, Y. Moriwaki, and R. Swaminathan

Copyright © 2013 Keiko Asao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D. Methods. We present a clinical case and a summary of literature search. Results. A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0 mg/mL He also had five small right lung nodules with a negative bone scan. Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL. The patient’s calcium was normalized after hydration, and he underwent radical nephrectomy. On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1 mg/dL. Pathology showed a 6 cm high-grade urothelial carcinoma with divergent differentiation. We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English. No cases have a documented elevated 1,25-dihydroxyvitamin D level. Conclusion. This clinical course suggests that hypercalcemia in this case is from the patient’s tumor, which was likely producing 1,25-dihydroxyvitamin D. Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D.