Rodríguez-Gutiérrez René, Zapata-Rivera Maria Azucena, Rodriguez-Velver Karla Victoria, Lavalle-Gonzalez Fernando J, Gonzalez-Gonzalez José Gerardo, Villarreal-Perez Jesus Zacarias
Endocrinology Division, Department of Internal Medicine, University Hospital 'Dr José E González', Unlversldad Autonoma de Nuevo León, Monterrey, México.
Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, US.
Eur Endocrinol. 2015 Aug;11(2):102-104. doi: 10.17925/EE.2015.11.02.102. Epub 2015 Aug 19.
The association of chronic tophaceous gout with severe hypercalcaemia is exceptional. In this case, a 42-year old man with a long-standing history of gout arrived at the emergency room with altered mental status. Laboratory work up revealed a uric acid of 14.0 mg/dl, corrected calcium of 14.5 mg/dl, phosphorous of 6.3 mg/dl, parathyroid hormone (PTH) was suppressed (<3.0 pg/ml), 25-dihydroxyvitamin D 25.2 ng/ml, parathyroid hormone related-protein (PTHrP) was 45.0 pg/ml and calcitriol 19.6 pg/ml. Biopsy histopathology result showed deposits of monosodium urate crystals surrounded by granulomatous inflammation. The association of chronic tophaceous gout with severe hypercalcaemia is extremely rare and has been usually described to be secondary to 1-25 dihydroxyvitamin D (calcitriol) secretion. In this case, calcitriol levels were normal and this possibility was excluded. On the other hand, PTHrP had never been, until now, described as the responsible cause of hypercalcaemia in gout. In our case, baseline PTHrP and calcium values were elevated and after medical treatment both returned to normal values. PTHrP usually causes hypophosphataemia and in this case the abnormal renal function could have diminished this last effect.
慢性痛风石性痛风与严重高钙血症的关联极为罕见。在此病例中，一名有长期痛风病史的42岁男性因精神状态改变被送至急诊室。实验室检查显示尿酸为14.0mg/dl，校正钙为14.5mg/dl，磷为6.3mg/dl，甲状旁腺激素（PTH）被抑制（<3.0pg/ml），25-二羟维生素D为25.2ng/ml，甲状旁腺激素相关蛋白（PTHrP）为45.0pg/ml，骨化三醇为19.6pg/ml。活检组织病理学结果显示尿酸钠晶体沉积并伴有肉芽肿性炎症。慢性痛风石性痛风与严重高钙血症的关联极其罕见，通常被认为继发于1,25-二羟维生素D（骨化三醇）分泌。在此病例中，骨化三醇水平正常，这种可能性被排除。另一方面，直到现在，PTHrP从未被描述为痛风中高钙血症的病因。在我们的病例中，基线PTHrP和钙值升高，经药物治疗后两者均恢复至正常水平。PTHrP通常会导致低磷血症，在此病例中，异常的肾功能可能减弱了这一最终效应。
