Ann Pediatr Endocrinol Metab.  2016 Jun;21(2):99-104. 10.6065/apem.2016.21.2.99.

A successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia

• Park HJ
• Choi EJ
• Kim JK

• KMID: 2328150
• DOI: http://doi.org/10.6065/apem.2016.21.2.99

Abstract

Severe hypercalcemia in children is a rare medical emergency. We present a case of a 15-year-old boy with hypercalcemia (total calcium level, 14.2 mg/dL) with a normal complete blood count, no circulating blasts in the peripheral blood film, and no other signs of acute lymphoblastic leukemia (ALL), including no signs of lymphadenopathy or hepatosplenomegaly. The hypercalcemia was successfully treated with zoledronic acid. As hypercalcemia can be the only presenting symptom of ALL in children, the diagnosis is often delayed. In children presenting with hypercalcemia, malignancies must be considered in the differential diagnosis.

Keyword

Hypercalcemia; Leukemia; Osteoclast activating factor

MeSH Terms

Adolescent*
Blood Cell Count
Calcium
Child
Diagnosis
Diagnosis, Differential
Emergencies
Humans
Hypercalcemia*
Leukemia
Lymphatic Diseases
Male*
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Calcium

Figure

• 

  Fig. 1 Rradiography of the pelvis showed focal osteolytic lesions in the intertrochanteric area of right femur (black arrow).

• 

  Fig. 2 A coronal spin echo T1-weighted magnetic resonance image showed diffuse decreased marrow signal intensity in the vertebral column, pelvic bones, and both femurs, and several focal osteonecrotic areas in both iliac wings and the intertrochanteric area of the right femur (white arrows).

• 

  Fig. 3 There was mild and diffusely increased tracer uptake on both proximal humeri and femurs on a whole body bone scan with 99mTc hydroxymethylene diphosphonate.

• 

  Fig. 4 Clinical courses; changes of serum calcium, phosphorus, creatinine level.

Reference

1. Davies JH, Shaw NJ. Investigation and management of hypercalcaemia in children. Arch Dis Child. 2012; 97:533–538. PMID: 22447996.

2. Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr. 2010; 22:508–515. PMID: 20601885.

3. McKay C, Furman WL. Hypercalcemia complicating childhood malignancies. Cancer. 1993; 72:256–260. PMID: 8508415.

4. Kerdudo C, Aerts I, Fattet S, Chevret L, Pacquement H, Doz F, et al. Hypercalcemia and childhood cancer: a 7-year experience. J Pediatr Hematol Oncol. 2005; 27:23–27. PMID: 15654274.

5. Trehan A, Cheetham T, Bailey S. Hypercalcemia in acute lymphoblastic leukemia: an overview. J Pediatr Hematol Oncol. 2009; 31:424–427. PMID: 19648791.

6. Hibi S, Funaki H, Ochiai-Kanai R, Ikushima S, Todo S, Sawada T, et al. Hypercalcemia in children presenting with acute lymphoblastic leukemia. Int J Hematol. 1997; 66:353–357. PMID: 9401281.

7. Inukai T, Hirose K, Inaba T, Kurosawa H, Hama A, Inada H, et al. Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormonerelated peptide and E2A-HLF from translocation 17;19. Leukemia. 2007; 21:288–296. PMID: 17183364.

8. Eastell R, Brandi ML, Costa AG, D'Amour P, Shoback DM, Thakker RV. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab. 2014; 99:3570–3579. PMID: 25162666.

9. Mirrakhimov AE. Hypercalcemia of malignancy: an update on pathogenesis and management. N Am J Med Sci. 2015; 7:483–493. PMID: 26713296.

10. Wysolmerski JJ. Parathyroid hormone-related protein: an update. J Clin Endocrinol Metab. 2012; 97:2947–2956. PMID: 22745236.

11. Sternlicht H, Glezerman IG. Hypercalcemia of malignancy and new treatment options. Ther Clin Risk Manag. 2015; 11:1779–1788. PMID: 26675713.

12. Niizuma H, Fujii K, Sato A, Fujiwara I, Takeyama J, Imaizumi M. PTHrP-independent hypercalcemia with increased proinflammatory cytokines and bone resorption in two children with CD19-negative precursor B acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007; 49:990–993. PMID: 16496289.

13. Lee YH, Lim YJ, Bae JJ, Kim JY, Shin JH. Hypercalcemia and extensive osteolytic lesion with increased plasma prostaglandin E2 level in a child with acute lymphoblastic leukemia. Korean J Hematol. 2007; 42:433–438.

14. Sargent JT, Smith OP. Haematological emergencies managing hypercalcaemia in adults and children with haematological disorders. Br J Haematol. 2010; 149:465–477. PMID: 20377591.

15. Baroncelli GI, Bertelloni S. The use of bisphosphonates in pediatrics. Horm Res Paediatr. 2014; 82:290–302. PMID: 25376487.

16. George S, Weber DR, Kaplan P, Hummel K, Monk HM, Levine MA. Short-term safety of zoledronic acid in young patients with bone disorders: an extensive institutional experience. J Clin Endocrinol Metab. 2015; 100:4163–4171. PMID: 26308295.

17. Kolyva S, Efthymiadou A, Gkentzi D, Karana-Ginopoulou A, Varvarigou A. Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature. J Pediatr Endocrinol Metab. 2014; 27:349–354. PMID: 23934636.

18. Lokadasan R, Prem S, Koshy SM, Jayasudha AV. Hypercalcaemia with disseminated osteolytic lesions: a rare presentation of childhood acute lymphoblastic leukaemia. Ecancermedicalscience. 2015; 9:542. PMID: 26082799.

19. Martins AL, Moniz M, Nunes PS, Abadesso C, Loureiro HC, Duarte X, et al. Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children. Rev Bras Ter Intensiva. 2015; 27:402–405. PMID: 26761480.