恶性肿瘤高钙血症：肉瘤患者甲状旁腺激素相关肽和1,25-二羟维生素D同时升高
Hypercalcemia of Malignancy: Simultaneous Elevation in Parathyroid Hormone-Related Peptide and 1,25 Dihydroxyvitamin D in Sarcoma.
作者信息
Kim Dong Won, Miller Ann, Li Andrew, Hardy Naomi, Silver Kristi D
机构信息
Division of General Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
出版信息
AACE Clin Case Rep. 2021 Jan 7;7(3):169-173. doi: 10.1016/j.aace.2020.11.037. eCollection 2021 May-Jun.
OBJECTIVE
Hypercalcemia is a common finding in patients who have an underlying malignancy. Only a few cases of hypercalcemia of malignancy have been linked to more than one mechanism of hypercalcemia. Here, we present a patient with liposarcoma and hypercalcemia of malignancy in the setting of simultaneous elevations in parathyroid hormone-related peptide (PTHrP) and 1,25 dihydroxyvitamin D [1,25(OH)D] levels. Sarcoma-associated hypercalcemia is a rare disorder.
METHODS
The patient was an 89-year-old woman with sarcoma-associated hypercalcemia. Multiple mechanisms were uncovered, and treatments were adjusted for them. Literature search for hypercalcemia of malignancy with multiple mechanisms was conducted.
RESULTS
This is the first report describing dual mechanisms of sarcoma-associated hypercalcemia and only the fifth report on PTHrP and 1,25(OH)D simultaneously causing hypercalcemia of malignancy.
CONCLUSION
Based on this finding, we recommend measuring the 1,25(OH)D levels in conjunction with the PTHrP level in patients with malignancy as this would allow for a more proactive approach to the diagnosis and treatment of hypercalcemia of malignancy.
目的
高钙血症在患有潜在恶性肿瘤的患者中很常见。仅有少数恶性肿瘤性高钙血症病例与不止一种高钙血症机制相关。在此，我们报告一例脂肪肉瘤患者，其在甲状旁腺激素相关肽（PTHrP）和1,25-二羟维生素D [1,25(OH)D] 水平同时升高的情况下发生恶性肿瘤性高钙血症。肉瘤相关性高钙血症是一种罕见疾病。
方法
该患者为一名89岁患有肉瘤相关性高钙血症的女性。发现了多种机制，并针对这些机制调整了治疗方案。对具有多种机制的恶性肿瘤性高钙血症进行了文献检索。
结果
这是首例描述肉瘤相关性高钙血症双重机制的报告，也是关于PTHrP和1,25(OH)D同时导致恶性肿瘤性高钙血症的第五例报告。
结论
基于这一发现，我们建议对恶性肿瘤患者同时检测PTHrP水平和1,25(OH)D水平，因为这将有助于更积极地诊断和治疗恶性肿瘤性高钙血症。
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