Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
BMJ Case Rep. 2021 Dec 30;14(12):e246669. doi: 10.1136/bcr-2021-246669.
Malignancy is the most common cause of hypercalcemia among hospitalised patients and is frequently caused by elevations in parathyroid hormone-related peptide (PTHrP). The most common PTHrP-producing cancers are carcinomas of the head, neck and lung. Hypercalcemia can be the presenting sign of cancer and, in these cases, solid tumours are usually discovered on CT scan. In rare cases, lymphoma may also present with hypercalcemia. CT scan is less sensitive for lymphoma than for most solid tumours and the diagnosis may be missed. We present the case of a 69-year-old woman who presented with hypercalcemia in the setting of severe weight loss and elevated PTHrP. Oncological workup was stopped after unrevealing CT scans and an underlying lymphoma was missed. Our case emphasises the need for a comprehensive oncological workup for patients with unexplained hypercalcemia and elevated PTHrP, even when CT scans are unrevealing.
恶性肿瘤是住院患者高钙血症最常见的原因，通常由甲状旁腺激素相关肽 (PTHrP) 升高引起。最常见的产生 PTHrP 的癌症是头颈部和肺癌的癌。高钙血症可能是癌症的首发症状，在这些情况下，通常可以通过 CT 扫描发现实体瘤。在极少数情况下，淋巴瘤也可能出现高钙血症。与大多数实体瘤相比，CT 扫描对淋巴瘤的敏感性较低，可能会漏诊。我们报告了一例 69 岁女性患者，因严重体重减轻和 PTHrP 升高而出现高钙血症。在未发现 CT 扫描后，停止了肿瘤学检查，从而漏诊了潜在的淋巴瘤。我们的病例强调了对于不明原因高钙血症和 PTHrP 升高的患者，即使 CT 扫描无异常，也需要进行全面的肿瘤学检查。
