Shionoiri A, Horiuchi T, Onouchi T, Tsutsumi H, Ohta M, Hosoi T, Ito H, Orimo H
Department of Endocrinology, Tokyo Metropolitan Geriatric Hospital.
Intern Med. 2000 Oct;39(10):810-3. doi: 10.2169/internalmedicine.39.810.
A 69-year-old man visited our department of neurology with symptoms of paresthesia on the lower extremities and lumbago. Biochemical examination of serum samples showed hypercalcemia (serum concentration 15.6 mg/dl). The levels of intact parathyroid hormone (i-PTH) and 1,25-dihydroxyvitamin D were suppressed, whereas parathyroid hormone-related peptide (PTHrP) was elevated up to 5.4 pM (normal range: below 0.6 pM). Additionally, bone survey revealed a punched-out lesion in radiological examinations of the skull. Bone marrow aspiration demonstrated many atypical plasma cells suggesting multiple myeloma. Nephrogenous cyclic adenosine monophosphate (cAMP), urinary deoxypyridinoline, plasma interleukin 6 (IL-6) and transforming growth factor beta (TGF beta) concentrations were elevated, whereas % of renal tubular reabsorption of phosphate (%TRP) was decreased. The immunohistochemical results demonstrated the expression of PTHrP in atypical plasma cells. These data indicated that hypercalcemia complicating multiple myeloma causes an elevation of renal calcium reabsorption and an increase of bone resorption mediated by PTHrP action.
一名69岁男性因下肢感觉异常和腰痛症状前来我院神经科就诊。血清样本生化检查显示高钙血症（血清浓度15.6mg/dl）。完整甲状旁腺激素（i-PTH）和1,25-二羟维生素D水平受到抑制，而甲状旁腺激素相关肽（PTHrP）升高至5.4pM（正常范围：低于0.6pM）。此外，骨骼检查显示颅骨放射学检查中有穿凿样病变。骨髓穿刺显示许多非典型浆细胞，提示多发性骨髓瘤。肾源性环磷酸腺苷（cAMP）、尿脱氧吡啶啉、血浆白细胞介素6（IL-6）和转化生长因子β（TGFβ）浓度升高，而肾小管磷重吸收率（%TRP）降低。免疫组化结果显示非典型浆细胞中有PTHrP表达。这些数据表明，多发性骨髓瘤并发的高钙血症导致肾钙重吸收增加和由PTHrP作用介导的骨吸收增加。
