Uchimura Keiko, Mokuno Takehiko, Nagasaka Akio, Hayakawa Nobuki, Kato Taiya, Yamazaki Naho, Kobayashi Takako, Nagata Mutsuko, Kotake Motoko, Itoh Mitsuyasu, Tsujimura Toru, Iwase Katsumi
Division of Endocrinology and Metabolism, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Metabolism. 2002 Jul;51(7):871-5. doi: 10.1053/meta.2002.33341.
In general, many cases of malignancy-associated hypercalcemia are due to HHM. In patients with humoral hypercalcemia of malignancy (HHM), it has been reported that plasma parathyroid hormone-related protein (PTHrP) and cyclic adenosine monophosphate (cAMP) levels were elevated, while plasma PTH and active vitamin D(3) levels were suppressed. Our patient showed hypercalcemia with a concurrent increase in plasma and tumor tissue PTHrP and PTH concentrations and also high cAMP and low 1-25(OH)(2)VD(3) levels in the plasma. These data suggest that the hypercalcemia exhibited by our patient was consistent with HHM due to lung cancer and its liver metastasis. Moreover, diagnostic imaging and autopsy findings showed no appreciable lesions of the parathyroid gland. In addition, histopathologic examination of the primary and metastatic tumors revealed the existence of PTH immunohistochemically stained with anti-PTH antibodies, suggesting an ectopic-PTH-producing lung tumor. From these data, our patient was diagnosed with a rare case of lung cancer, which produced both ectopic PTH and PTHrP.
一般来说，许多恶性肿瘤相关性高钙血症病例是由恶性肿瘤体液性高钙血症（HHM）引起的。在恶性肿瘤体液性高钙血症（HHM）患者中，据报道血浆甲状旁腺激素相关蛋白（PTHrP）和环磷酸腺苷（cAMP）水平升高，而血浆甲状旁腺激素（PTH）和活性维生素D（3）水平受到抑制。我们的患者表现为高钙血症，同时血浆和肿瘤组织中的PTHrP及PTH浓度升高，血浆中cAMP水平也高，而1,25-二羟维生素D3[1,25(OH)2VD3]水平低。这些数据表明，我们的患者所表现出的高钙血症与肺癌及其肝转移所致的HHM一致。此外，诊断性影像学检查和尸检结果显示甲状旁腺无明显病变。另外，对原发性和转移性肿瘤的组织病理学检查显示，用抗PTH抗体进行免疫组织化学染色可发现PTH的存在，提示存在产生异位PTH的肺肿瘤。根据这些数据，我们的患者被诊断为一例罕见的既产生异位PTH又产生PTHrP的肺癌病例。
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