Abstract: SA-PO1023

Erythropoietin Producing Glioblastoma Multiforme in a Patient with ESRD

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Naing, Min, New York Presbyterian Queens, Flushing, New York, United States
  • Yousaf, Farhanah, New York Presbyterian Queens, Flushing, New York, United States
  • Urrutia, Andres Amalio, Vanderbilt University Medical Center, Nashville,, Tennessee, United States
  • Haase, Volker H., Vanderbilt University Medical Center, Nashville,, Tennessee, United States
  • Goldberg, Alla, New York Presbyterian Queens, Flushing, New York, United States
  • Spinowitz, Bruce S., New York Presbyterian Queens, Flushing, New York, United States
Background

Elevated hemoglobin (Hgb) is rare in patients undergoing hemodialysis and may be associated with malignancy, polycythemia vera, nephroangiosclerosis, lung or liver disease or acquired cystic kidney disease. We report a rare case of elevated Hgb associated with glioblastoma multiforme (GBM).

Methods

A 66-year-old, white, non-Hispanic male with history of hypertension, diabetes mellitus type 2, dyslipidemia, secondary hyperparathyroidism on maintenance hemodialysis since March 2010 presented to our center in May 2015 with elevated Hgb. Physical exam was unremarkable.
Patient’s erythropoietin (EPO) level was elevated to 42.7 mlU/mL during 2014 but evaluation for erythrocytosis did not reveal any suspicious lesion on abdominal ultrasound.The EPO level continued to rise to 116 mIU/mL with Hgb 18 g/dL and JAK-2 V617F mutation analysis was negative by July 2015. An EPO producing tumor seemed likely but only splenomegaly was evident on CT abdomen and pelvis . On March 2016, transferrin saturation had fallen to 17% and ferritin was 60 ng/mL with a resultant Hgb drop (10 g/dL) and received 2 doses of 300 mg of IV iron sucrose which increased Hgb to 11.4 g/dL. Leukocytes and platelets remained in the normal range.
In April 2016, patient was evaluated for depression and memory problems. All the tests were unremarkable except elevated thyroid stimulating hormone. CT head revealed a right frontal GBM which was resected and he underwent radiation therapy. Hgb fell and he received multiple blood transfusions while ESAs were contraindicated. Two months post resection, EPO level was 9.4 mIU/mL. He expired in Oct 2016 after withdrawing from hemodialysis. GBM tissue sample slides were analyzed using EPO mRNA fluorescent in situ hybridization which showed low levels of EPO mRNA throughout the GBM tissue sample except in necrotic areas.

Conclusion

This is the first case report of an EPO producing GBM. The expression of EPO mRNA in the GBM tissue and the temporal relationship of changes in EPO and Hgb levels with respect to the GBM resection strongly support GBM as the ectopic EPO production site.