PD819 - BEYOND HYPERCALCEMIA: NUTRITIONAL IMPAIRMENT IN PTHRP-PRODUCING PANCREATIC NEUROENDOCRINE TUMORS

PD819

BEYOND HYPERCALCEMIA: NUTRITIONAL IMPAIRMENT IN PTHRP-PRODUCING PANCREATIC NEUROENDOCRINE TUMORS

O. Jermakova^1,*, A. Llenas Blade^1,2, A. R. Gonzalez¹, M. Bellver¹, M. Choulli¹, L. Arribas^1,2, M. Puig Figueras^1,2, A. Florez Romero³, I. Peiro¹

¹Clinical Nutrition Unit, Catalan Institute of Oncology, ²Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, ³Endocrinology department, Fundación Santa Fé, Bogotá, Spain

Rationale: Pancreatic neuroendocrine tumors (PNETs) are a rare cause of parathyroid hormone-related protein (PTHrP)-mediated hypercalcemia (HC), which is associated with tumor-induced cachexia and muscle wasting. 

Methods: A case series of PNET patients with PTHrP-associated HC. Patients were evaluated at baseline, at PTHrP positivity, and upon normalization of calcium or PTHrP. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment, and inflammation with the modified Glasgow Prognostic Score (mGPS) and neutrophil-lymphocyte ratio (NLR). Body composition was analyzed using a single CT slice at the L3 level.

Results: Seven patients (71% male) with median age of 59 [49–60] years were included. At diagnosis, six patients (85%) had well-differentiated PNETs, and one had neuroendocrine carcinoma. Two patients presented with HC at PNET diagnosis, severe malnutrition/cachexia, mGPS 2, and NLR >3; both were refractory to treatment and died within months. Five patients developed PTHrP positivity during disease progresion (two with baseline malnutrition). At hypercalcemia onset, 86% had metastatic disease, while one presented with locally advanced disease.. All patients experienced significant weight loss (median 10% [8–15]), and developed moderate to severe malnutrition and cachexia. Four patients received nutritional support, including one requiring enteral nutrition. Two patients achieved normalization of calcium or PTHrP, showing weight recovery or stabilization and those who did not experienced further nutritional deterioration. CT-based body composition analysis is ongoing and will be presented at the congress.

Conclusion: In PNETs, PTHrP is associated with malnutrition, cachexia, and poor outcomes. Normalization of PTHrP is associated with improvement in nutritional status, highlighting the need for early monitoring and nutritional support in these high-risk patients.

Disclosure of Interest: None declared