Lim S C, Tan C E, Aw T C, Khoo D, Eng P, Ho S C, Tai E S, Fok A
Department of Endocrinology, Singapore General Hospital, Singapore.
Singapore Med J. 2000 Feb;41(2):74-6.
We report a case of an 80-year-old man with osteoblastic metastases from advanced carcinoma of the prostate presenting with a grand mal seizure resulting from severe hypocalcaemia. He had low serum phosphate and ionised calcium levels, elevated serum skeletal alkaline phosphatase and intact parathormone levels. 99mTc radioisotope bone scan revealed a "super bone scan" suggestive of osteomalacia. The serum 1, 25-dihydroxycholecalciferol level was unexpectedly elevated. The biochemical abnormalities persisted despite high dose calcium replacement, but improved with supraphysiological doses of 1,25 (OH)2 vitamin D3 (Rocaltrol) therapy. We hypothesise that the hypocalcaemia in this patient was due to vitamin D resistance secondary to a humoral factor secreted by the tumour.
我们报告一例80岁男性，患有前列腺癌晚期成骨性转移，因严重低钙血症出现癫痫大发作。他的血清磷酸盐和离子钙水平较低，血清骨碱性磷酸酶和完整甲状旁腺激素水平升高。99mTc放射性核素骨扫描显示“超级骨扫描”，提示骨软化症。血清1,25 - 二羟胆钙化醇水平意外升高。尽管进行了高剂量补钙，生化异常仍持续存在，但超生理剂量的1,25(OH)2维生素D3（罗钙全）治疗使其得到改善。我们推测该患者的低钙血症是由于肿瘤分泌的体液因子导致维生素D抵抗所致。
