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Reiko Yamada [1] and Kyosuke Tanaka [2] and Hiroyuki Inoue [1] and Takashi Sakuno [1] and Tetsuro Harada [1] and Naohiko Yoshizawa [1] and Hiroshi Miura [1] and Toshihumi Takeuchi [1] and Misaki Nakamura [1] and Masaki Katsurahara [2] and Yasuhiko Hamada [2] and Noriyuki Horiki [2] and Yoshiyuki Takei [1]
Academic Editor: Peter F. Lenehan
1, Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan, mie-u.ac.jp
2, Department of Endoscopy, Mie University School of Medicine, Tsu, Japan, mie-u.ac.jp
Received Apr 29, 2017; Revised Jul 3, 2017; Accepted Jul 16, 2017
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.
1. Introduction
Paraneoplastic syndromes are sometimes seen in patients with advanced malignancies. Tumors that produce parathyroid hormone-related protein (PTH-rP) can cause a paraneoplastic syndrome characterized by hypercalcemia [1]. The PTH-rP concentration is elevated in more than 90% of patients with squamous cell, renal, ovarian, breast, and endometrial cancer or human T-lymphotropic virus-associated lymphoma [1, 2]; however, it is rarely elevated in patients with pancreatic adenocarcinoma [3–6]. Hence, paraneoplastic production of PTH-rP by pancreatic adenocarcinomas is highly unlikely. We herein report a rare case of a pancreatic adenocarcinoma that produced PTH-rP, resulting in hypercalcemia.
2. Case Report
A 48-year-old woman was referred to our hospital with a 1-year history of a continuous high fever. Significant events in her medical history included Graves’ disease at 39 years of age and the removal of an ovarian cyst at 45 years of age. At the first time when she presented to the referring hospital with a high fever, computed tomography (CT) showed no apparent lesion. After surveillance, her fever was initially thought to be due to tonsillitis. A tonsillectomy was performed at the referring hospital; however, the fever persisted. Follow-up CT revealed a pancreatic body mass and multiple liver masses. Based on these findings, the patient was subsequently referred to our institution for further examination.
Initial laboratory tests showed leukocytosis (white blood cell count, 17,930/mm3) and an elevated serum C-reactive protein (CRP) concentration (16.79 mg/dL) (Table 1). Blood cultures taken several times showed no signs of infection. Contrast-enhanced CT revealed a pancreatic...