HYPERCALCEMIA MIMICKING SYMPTOMS OF BRAIN METASTASES IN PATIENT WITH RENAL CELL CARCINOMA

37 year-old man with renal-cell carcinoma presented with lethargy, hallucination, nausea vomiting and constipation 12 months after the operation. Two months before admission, the patient had received cranial radiotherapy for multiple brain metastases. These symptoms were thought to be due to the progression of brain metastases. A cranial CT scan showed stable disease in the brain. Serum calcium level however, was 20.6 mg/dl. With the diagnosis of cancer-related hypercalcemia, he was treated with hydration and pamidronate. Calcium level decreased to the normal range and the patient's symptoms disappeared completely. Cancer-related hypercalcemia is the most common paraneoplastic metabolic disorder, but very high levels of serum calcium is rare in cancer patients. Hypercalcemia-associated symptoms may be overlooked because of disease dissemination, and other factors contributing to poor performance status.

Keywords: hypercalcemia, renal cell carcinoma, brain metastases