Parathyroid Hormone Secreting Metaplastic Breast Carcinoma: A Case Report of Paraneoplastic Syndrome

Paraneoplastic syndrome (PNS) is a distant neurological manifestation of an underlying tumour. Humoral hypercalcaemia of malignancy is a form of paraneoplastic syndrome where there is an increased in calcium levels. In this article we report a 48 year old lady, with no known medical illness and presented with symptomatic hypercalcaemia. She presented to our institution complaining of a fungating and ulcerating mass over the right breast, measuring 11 X 15 cm and associated with gradual paraxial body weakness. Further investigations revealed the lesion to be an invasive breast carcinoma with metaplastic features. Computed tomography (CT) scan showed a locally advanced breast carcinoma with right axillary node metastasis, without evidence of distant metastasis. Serum calcium, i-PTH together with SPECT has confirmed the patient to have a humoral hypercalcaemia malignancy with elevated ectopic parathyroid hormone level. Bone scan did not reveal any evidence of metastasis. High volume intake and loop diuretics were employed in the management of hypercalcaemia, which was eventually resolved following mastectomy with axillary clearance of the ipsilateral side. Currently she’s she is under oncologist’s follow up for further management.

Two Cases of Pseudohyperkalemia that Occurred after Emergency Splenectomy: What Goes Up, Will Come Down

Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.