SHM Converge Scientific Abstract ePoster Gallery-Hypercalcemia-Induced Encephalopathy and Acute Stroke in a Young Woman With Metastatic Pancreatic Cancer

Pdf Summary

This case describes a 27-year-old woman with metastatic pancreatic tail adenocarcinoma who presented with 2 days of worsening altered mental status, severe cancer-related pain, and constipation after cycle 2 of gemcitabine and Abraxane. Her history included prior deep vein thrombosis, pulmonary embolism, thrombocytopenia preventing anticoagulation, an inferior vena cava filter, and prior cerebrovascular accident.<br /><br />Workup revealed profound hypercalcemia (corrected calcium 16.7 mg/dL), low magnesium and phosphorus, suppressed parathyroid hormone, and markedly elevated parathyroid hormone–related peptide (PTHrP), supporting humoral hypercalcemia of malignancy (HHM). Brain and neck imaging showed an anterior pontine infarct and a right insular subacute infarct, but neurology found no acute neurologic explanation for her encephalopathy. Clinicians concluded that hypercalcemia was a major contributor to her mental status changes, while her vascular disease and advanced cancer likely contributed to stroke risk.<br /><br />She was treated with intravenous fluids, zoledronic acid (Zometa), calcitonin, and electrolyte replacement. The report emphasizes that severe hypercalcemia can cause confusion, lethargy, coma, and cognitive changes. Although HHM is classically associated with squamous cell cancers, it can rarely occur in pancreatic adenocarcinoma through PTHrP production.<br /><br />The authors highlight the importance of considering metabolic causes, especially paraneoplastic hypercalcemia, when evaluating encephalopathy in cancer patients. Early recognition and treatment are essential, but prognosis is often poor in the setting of advanced malignancy.

Asset Subtitle

Ashraf Abulhaija

Meta Tag

Author List Anette Newby-Stephan, Ashraf Abulhaija, Holly O'Brien, Ian Loy, Jessica R. Glover

Category Clinical Vignettes

Concept Hypercalcemia

Concept Encephalopathy

Concept Hypercalcemia of Malignancy

Concept Severe Hypercalcemia

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization Moffitt Cancer Center and Colorado Technical University

Presenting Author Ashraf Abulhaija

Track Adult

Keywords

metastatic pancreatic adenocarcinoma

hypercalcemia of malignancy

parathyroid hormone-related peptide

altered mental status

zoledronic acid

calcitonin

gemcitabine

Abraxane

pancreatic cancer

encephalopathy

Hypercalcemia

Encephalopathy

Hypercalcemia of Malignancy

Severe Hypercalcemia

Altered Mental Status