Notman D D, Krauss D J, Moses A M
Am J Med. 1979 May;66(5):870-3. doi: 10.1016/0002-9343(79)91140-9.
Refractory hypercalcemia developed suddenly in a patient who had undergone a radical cystectomy for an anaplastic transitional cell carcinoma of the bladder. A normal serum parathyroid hormone (PTH) value was obtained by immunoassay while the patient had hypercalcemia and unimpaired renal function. This normal PTH value in the presence of hypercalcemia was consistent with his hypercalcemia being secondary to excessive amounts of circulating PTH. The finding of increased nephrogenous cyclic AMP, however, provided the definitive diagnosis of hyyperparathyroidism. Since autopsy revealed that there was no residual tumor in the bladder area, only evidence of metastatic disease, and since the parathyroid glands were not hyperplastic or adenomatous, we attributed this patient's hypercalcemia to hyperparathyroidism due to the ectopic production of PTH by a metastasis from the transitional cell carcinoma of the bladder.
一名因膀胱间变性移行细胞癌接受根治性膀胱切除术的患者突然出现难治性高钙血症。患者高钙血症且肾功能未受损时，免疫测定血清甲状旁腺激素（PTH）值正常。高钙血症时PTH值正常，这与他的高钙血症继发于循环中PTH过量一致。然而，肾源性环磷酸腺苷增加的发现提供了甲状旁腺功能亢进的确切诊断。尸检显示膀胱区域无残留肿瘤，仅有转移病灶证据，且甲状旁腺未增生或腺瘤样变，我们将该患者的高钙血症归因于膀胱移行细胞癌转移灶异位产生PTH导致的甲状旁腺功能亢进。
