Sheehan Michael, Tanimu Sabo, Tanimu Yusuf, Engel Jessica, Onitilo Adedayo
Department of Endocrinology, Marshfield Medical Center - Weston, Weston, Wisconsin, USA.
Department of Gastroenterology, Marshfield Medical Center - Weston, Weston, Wisconsin, USA.
Case Rep Oncol. 2020 Mar 25;13(1):321-329. doi: 10.1159/000506100. eCollection 2020 Jan-Apr.
Hypercalcemia is an ominous development in the course of malignancy associated with a mean survival of only several months. A majority of cases of hypercalcemia are related to humoral hypercalcemia of malignancy (HHM), where hypercalcemia is caused by increased levels of circulating parathyroid hormone-related protein (PTHrP). Mainstay treatments in the management of HHM are intravenous fluids, intravenous bisphosphonates, and subcutaneous denosumab, although hypercalcemia oftentimes recurs despite these efforts. We present a case of advanced non-small cell lung cancer with PTHrP-mediated hypercalcemia that proved resistant to standard therapy. A trial of oral cinacalcet was initiated and improved calcium levels for 2 months despite a progressive rise in PTHrP and prior to subsequent disease progression. Based on the current body of literature, we propose that this calcium-lowering effect of cinacalcet occurs due to a potential effect on renal calcium excretion.
高钙血症是恶性肿瘤病程中的一个不祥进展，平均生存期仅数月。大多数高钙血症病例与恶性肿瘤体液性高钙血症（HHM）有关，其中高钙血症是由循环中甲状旁腺激素相关蛋白（PTHrP）水平升高引起的。HHM治疗的主要方法是静脉补液、静脉注射双膦酸盐和皮下注射地诺单抗，尽管如此，高钙血症仍常常复发。我们报告一例晚期非小细胞肺癌伴PTHrP介导的高钙血症病例，该病例对标准治疗耐药。启动了口服西那卡塞试验，尽管PTHrP逐渐升高且在随后疾病进展之前，但钙水平在2个月内有所改善。基于目前的文献资料，我们认为西那卡塞的这种降钙作用是由于对肾钙排泄的潜在影响所致。
