肺腺癌中甲状旁腺激素（PTH）和甲状旁腺激素相关蛋白（PTHRP）共同分泌导致的恶性肿瘤性高钙血症
Hypercalcemia of Malignancy Attributed to Cosecretion of PTH and PTHRP in Lung Adenocarcinoma.
作者信息
Kroopnick Jeffrey M, Martinez-Outschoorn Ubaldo, Tuluc Madalina, Kim Caroline S
机构信息
Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medical Oncology, Jefferson University Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
出版信息
AACE Clin Case Rep. 2021 Jan 19;7(3):200-203. doi: 10.1016/j.aace.2021.01.003. eCollection 2021 May-Jun.
INTRODUCTION
Hypercalcemia of malignancy (HCM) portends a very poor prognosis, and no established guidelines exist regarding its management. Most instances of HCM are due to local osteolysis or secretion of parathyroid hormone related-peptide, while less than 1% of all cases are due to ectopic secretion of parathyroid hormone.
CASE REPORT
We present an unusual case of HCM due to proposed cosecretion of both parathyroid hormone and parathyroid hormone-related protein in a 36-year-old man with a poorly differentiated lung adenocarcinoma. The patient's hypercalcemia was refractory to conventional measures, including intravenous bisphosphonate therapy (zoledronic acid), and was improved with administration of denosumab.
CONCLUSION
This is the youngest and first case of hypercalcemia of malignancy attributed to cosecretion of PTH and PTHrP from an adenocarcinoma. In refractory cases of HCM, denosumab is a potential option when other conventional measures are unsuccessful.
引言
恶性肿瘤高钙血症（HCM）预后极差，目前尚无关于其治疗的既定指南。大多数HCM病例是由于局部骨溶解或甲状旁腺激素相关肽的分泌，而所有病例中不到1%是由于甲状旁腺激素的异位分泌。
病例报告
我们报告一例不寻常的HCM病例，该病例发生在一名36岁的低分化肺腺癌男性患者身上，推测其甲状旁腺激素和甲状旁腺激素相关蛋白共同分泌。患者的高钙血症对包括静脉注射双膦酸盐治疗（唑来膦酸）在内的传统措施无效，而使用地诺单抗后病情有所改善。
结论
这是最年轻且首例由腺癌同时分泌甲状旁腺激素和甲状旁腺激素相关蛋白导致的恶性肿瘤高钙血症病例。在HCM的难治性病例中，当其他传统措施无效时，地诺单抗是一种潜在的选择。
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