Pancreatitis, hypercalcemia, and breast carcinoma.

To the Editor.— I refer to the article entitled "Acute Pancreatitis Secondary to Hypercalcemia: Occurrence in a Patient With Breast Carcinoma" by Gafter et al (235:2004, 1976). In this article, the authors conclude by stating: "The present report provides another example of pancreatitis due to hypercalcemia of nonparathyroid origin." Although the patient described by the authors had disseminated carcinoma of the breast and had only one normal parathyroid gland identified at postmortem examination, I do not think the evidence supporting their conclusion that her acute pancreatitis was due to the hypercalcemia related to her breast tumor is very strong. The patient they described not only had hypercalcemia and carcinoma of the breast, but also had hypophosphatemia. Several previous investigations have documented that patients with hypophosphatemia, hypercalcemia, and breast cancer have coexistent parathyroid tumors. 1-4 Breast cancers secrete substances that do not cause hypophosphatemia. 5-6 Thus, in patients with hypercalcemia caused