Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma

Jay M Lee; Karla Pou; Peter M Sadow; Hong Chen; Bei Hu; Martin Hewison; John S Adams; David J Sugarbaker; Naomi D L Fisher

doi:10.4158/EP.14.8.1011

Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma

Jay M Lee, Karla Pou, Peter M Sadow, Hong Chen, Bei Hu, Martin Hewison, John S Adams, David J Sugarbaker, Naomi D L Fisher

Metabolism and Systems Research

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

OBJECTIVE: To report a case of coincident hypercalcemia and Cushing syndrome arising from mesothelioma.

METHODS: We describe the clinical, laboratory, imaging, and pathologic findings of a patient with malignant pleural mesothelioma and elucidate the underlying biologic mechanisms resulting in concurrent overexpression of steroid and polypeptide hormones.

RESULTS: A 62-year-old woman presented with chest discomfort and cough. Radiologic imaging revealed a diffuse pleural-based mass encasing the right lung. There was no invasion into the chest wall, diaphragm, or mediastinum, and there was no distant disease. Laboratory analyses documented hypercalcemia and Cushing syndrome, which were due to ectopic overproduction of 1,25-dihydroxyvitamin D (1,25[OH](2)D) and corticotropin. Surgical resection resulted in normocalcemia with normalization of serum 1,25(OH)(2)D and reduction in hypercortisolemia. The extrapleural pneumonectomy specimen revealed overexpression of the 1,25(OH)(2)D synthetic enzyme 25-hydroxyvitamin-D-1alpha-hydroxylase (1alpha-hydroxylase) and underexpression of the 1,25(OH)(2)D catabolic enzyme 24-hydroxylase. Immunohistochemistry and electron microscopy demonstrated corticotropin and secretory granules in the tumor tissue.

CONCLUSION: These findings support the evidence for a paracrine role of vitamin D in the resistance of the human host to antigen.

Original language	English
Pages (from-to)	1011-6
Number of pages	6
Journal	Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Volume	14
Issue number	8
DOIs	https://doi.org/10.4158/EP.14.8.1011
Publication status	Published - Nov 2008

Keywords

Cushing Syndrome
Humans
Hypercalcemia
Male
Mesothelioma
Middle Aged
Pleural Neoplasms
Vitamin D

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.4158/EP.14.8.1011

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Lee, J. M., Pou, K., Sadow, P. M., Chen, H., Hu, B., Hewison, M., Adams, J. S., Sugarbaker, D. J., & Fisher, N. D. L. (2008). Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 14(8), 1011-6. https://doi.org/10.4158/EP.14.8.1011

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title = "Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma",

abstract = "OBJECTIVE: To report a case of coincident hypercalcemia and Cushing syndrome arising from mesothelioma.METHODS: We describe the clinical, laboratory, imaging, and pathologic findings of a patient with malignant pleural mesothelioma and elucidate the underlying biologic mechanisms resulting in concurrent overexpression of steroid and polypeptide hormones.RESULTS: A 62-year-old woman presented with chest discomfort and cough. Radiologic imaging revealed a diffuse pleural-based mass encasing the right lung. There was no invasion into the chest wall, diaphragm, or mediastinum, and there was no distant disease. Laboratory analyses documented hypercalcemia and Cushing syndrome, which were due to ectopic overproduction of 1,25-dihydroxyvitamin D (1,25[OH](2)D) and corticotropin. Surgical resection resulted in normocalcemia with normalization of serum 1,25(OH)(2)D and reduction in hypercortisolemia. The extrapleural pneumonectomy specimen revealed overexpression of the 1,25(OH)(2)D synthetic enzyme 25-hydroxyvitamin-D-1alpha-hydroxylase (1alpha-hydroxylase) and underexpression of the 1,25(OH)(2)D catabolic enzyme 24-hydroxylase. Immunohistochemistry and electron microscopy demonstrated corticotropin and secretory granules in the tumor tissue.CONCLUSION: These findings support the evidence for a paracrine role of vitamin D in the resistance of the human host to antigen.",

keywords = "Cushing Syndrome, Humans, Hypercalcemia, Male, Mesothelioma, Middle Aged, Pleural Neoplasms, Vitamin D",

author = "Lee, {Jay M} and Karla Pou and Sadow, {Peter M} and Hong Chen and Bei Hu and Martin Hewison and Adams, {John S} and Sugarbaker, {David J} and Fisher, {Naomi D L}",

year = "2008",

month = nov,

doi = "10.4158/EP.14.8.1011",

language = "English",

volume = "14",

pages = "1011--6",

journal = "Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists",

issn = "1530-891X",

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Lee, JM, Pou, K, Sadow, PM, Chen, H, Hu, B, Hewison, M, Adams, JS, Sugarbaker, DJ & Fisher, NDL 2008, 'Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma', Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 14, no. 8, pp. 1011-6. https://doi.org/10.4158/EP.14.8.1011

Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma. / Lee, Jay M; Pou, Karla; Sadow, Peter M et al.
In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, Vol. 14, No. 8, 11.2008, p. 1011-6.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma

AU - Lee, Jay M

AU - Pou, Karla

AU - Sadow, Peter M

AU - Chen, Hong

AU - Hu, Bei

AU - Hewison, Martin

AU - Adams, John S

AU - Sugarbaker, David J

AU - Fisher, Naomi D L

PY - 2008/11

Y1 - 2008/11

N2 - OBJECTIVE: To report a case of coincident hypercalcemia and Cushing syndrome arising from mesothelioma.METHODS: We describe the clinical, laboratory, imaging, and pathologic findings of a patient with malignant pleural mesothelioma and elucidate the underlying biologic mechanisms resulting in concurrent overexpression of steroid and polypeptide hormones.RESULTS: A 62-year-old woman presented with chest discomfort and cough. Radiologic imaging revealed a diffuse pleural-based mass encasing the right lung. There was no invasion into the chest wall, diaphragm, or mediastinum, and there was no distant disease. Laboratory analyses documented hypercalcemia and Cushing syndrome, which were due to ectopic overproduction of 1,25-dihydroxyvitamin D (1,25[OH](2)D) and corticotropin. Surgical resection resulted in normocalcemia with normalization of serum 1,25(OH)(2)D and reduction in hypercortisolemia. The extrapleural pneumonectomy specimen revealed overexpression of the 1,25(OH)(2)D synthetic enzyme 25-hydroxyvitamin-D-1alpha-hydroxylase (1alpha-hydroxylase) and underexpression of the 1,25(OH)(2)D catabolic enzyme 24-hydroxylase. Immunohistochemistry and electron microscopy demonstrated corticotropin and secretory granules in the tumor tissue.CONCLUSION: These findings support the evidence for a paracrine role of vitamin D in the resistance of the human host to antigen.

AB - OBJECTIVE: To report a case of coincident hypercalcemia and Cushing syndrome arising from mesothelioma.METHODS: We describe the clinical, laboratory, imaging, and pathologic findings of a patient with malignant pleural mesothelioma and elucidate the underlying biologic mechanisms resulting in concurrent overexpression of steroid and polypeptide hormones.RESULTS: A 62-year-old woman presented with chest discomfort and cough. Radiologic imaging revealed a diffuse pleural-based mass encasing the right lung. There was no invasion into the chest wall, diaphragm, or mediastinum, and there was no distant disease. Laboratory analyses documented hypercalcemia and Cushing syndrome, which were due to ectopic overproduction of 1,25-dihydroxyvitamin D (1,25[OH](2)D) and corticotropin. Surgical resection resulted in normocalcemia with normalization of serum 1,25(OH)(2)D and reduction in hypercortisolemia. The extrapleural pneumonectomy specimen revealed overexpression of the 1,25(OH)(2)D synthetic enzyme 25-hydroxyvitamin-D-1alpha-hydroxylase (1alpha-hydroxylase) and underexpression of the 1,25(OH)(2)D catabolic enzyme 24-hydroxylase. Immunohistochemistry and electron microscopy demonstrated corticotropin and secretory granules in the tumor tissue.CONCLUSION: These findings support the evidence for a paracrine role of vitamin D in the resistance of the human host to antigen.

KW - Cushing Syndrome

KW - Humans

KW - Hypercalcemia

KW - Male

KW - Mesothelioma

KW - Middle Aged

KW - Pleural Neoplasms

KW - Vitamin D

U2 - 10.4158/EP.14.8.1011

DO - 10.4158/EP.14.8.1011

M3 - Article

C2 - 19095601

SN - 1530-891X

VL - 14

SP - 1011

EP - 1016

JO - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

JF - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

IS - 8

ER -

Vitamin D-mediated hypercalcemia and Cushing syndrome as manifestations of malignant pleural mesothelioma

Abstract

Keywords

UN SDGs

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