Fukumoto S, Matsumoto T, Ikeda K, Yamashita T, Watanabe T, Yamaguchi K, Kiyokawa T, Takatsuki K, Shibuya N, Ogata E
Fourth Department of Internal Medicine, University of Tokyo School of Medicine, Japan.
Arch Intern Med. 1988 Apr;148(4):921-5.
To clarify the mechanism of development of hypercalcemia in adult T-cell leukemia/lymphoma (ATLL), ten patients with a serum creatinine level less than 177 mumol/L (2 mg/dL) were examined. Although hypercalcemia was seen in only four (40%) of these patients, four of six normocalcemic patients showed hypercalciuria (greater than 5 mmol/d [greater than 200 mg/24 h]). All hypercalcemic patients exhibited high nephrogenous cyclic adenosine monophosphate (NcAMP) levels in the face of low-normal immunoreactive parathyroid hormone and reduced serum 1,25-dihydroxyvitamin D [1,25(OH)2D] concentration. Half of the hypercalciuric patients with normocalcemia also showed high NcAMP and reduced serum 1,25(OH)2D levels. Furthermore, the changes in NcAMP and serum 1,25(OH)2D concentration closely paralleled the development of hypercalcemia and hypercalciuria in two patients. These results are reminiscent of the syndrome of humoral hypercalcemia of malignancy and suggest that derangements in calcium metabolism develop by a similar mechanism in patients with ATLL. The present data also indicate the importance of the measurement of urinary calcium excretion for early detection and prevention of fatal hypercalcemia in patients with ATLL.
为阐明成人T细胞白血病/淋巴瘤（ATLL）患者高钙血症的发生机制，对10例血清肌酐水平低于177μmol/L（2mg/dL）的患者进行了检查。尽管这些患者中只有4例（40%）出现高钙血症，但6例血钙正常的患者中有4例出现高钙尿症（大于5mmol/d[大于200mg/24h]）。所有高钙血症患者在免疫反应性甲状旁腺激素水平低至正常且血清1,25 - 二羟维生素D[1,25(OH)2D]浓度降低的情况下，均表现出高肾源性环磷酸腺苷（NcAMP）水平。半数血钙正常的高钙尿症患者也表现出高NcAMP水平和降低的血清1,25(OH)2D水平。此外，在2例患者中，NcAMP和血清1,25(OH)2D浓度的变化与高钙血症和高钙尿症的发展密切相关。这些结果使人联想到恶性肿瘤体液性高钙血症综合征，并提示ATLL患者钙代谢紊乱是通过类似机制发生的。目前的数据还表明，测量尿钙排泄量对于早期发现和预防ATLL患者致命性高钙血症具有重要意义。
