Solimando D A
Oncology Pharmacy Services, Inc., 4201 Wilson Boulevard, #110-545, Arlington, VA 22203, USA.
Am J Health Syst Pharm. 2001 Nov 15;58 Suppl 3:S4-7. doi: 10.1093/ajhp/58.suppl_3.S4.
The etiology, pathophysiology, and diagnosis of hypercalcemia associated with malignant diseases are discussed. In humans, calcium is controlled by three mechanisms: parathyroid hormone, which regulates bone resorption and renal reabsorption of calcium; calcitonin, an antagonist of parathyroid hormone; and cholecalciferol, which regulates calcium absorption from the gastrointestinal tract. Hypercalcemia of malignancy (HCM) results primarily from increased bone resorption by osteoclasts and, to a lesser extent, from increased renal tubular reabsorption. In most tumors, parathyroid hormone-related protein (PTHrP) is the primary mediator of calcium. PTHrP stimulates increased bone resorption by osteoclasts. This stimulation also activates transforming growth factor-beta (TGF-beta), which stimulates tumor cells, thus perpetuating the cycle. Hypercalcemia is usually defined as a serum calcium concentration greater than 12 mg/dL, corrected for the serum albumin concentration. In diagnosing HCM, it is important to rule out other causes of hypercalcemia, such as primary hyperparathyroidism.
本文讨论了与恶性疾病相关的高钙血症的病因、病理生理学及诊断。在人体中，钙受三种机制控制：甲状旁腺激素，调节骨吸收及肾脏对钙的重吸收；降钙素，甲状旁腺激素的拮抗剂；以及胆钙化醇，调节胃肠道对钙的吸收。恶性肿瘤相关性高钙血症（HCM）主要源于破骨细胞引起的骨吸收增加，在较小程度上源于肾小管重吸收增加。在大多数肿瘤中，甲状旁腺激素相关蛋白（PTHrP）是钙的主要介质。PTHrP刺激破骨细胞增加骨吸收。这种刺激还激活转化生长因子-β（TGF-β），后者刺激肿瘤细胞，从而使这个循环持续下去。高钙血症通常定义为校正血清白蛋白浓度后血清钙浓度大于12mg/dL。在诊断HCM时，排除高钙血症的其他病因（如原发性甲状旁腺功能亢进）很重要。
