Breslau N A, McGuire J L, Zerwekh J E, Frenkel E P, Pak C Y
Ann Intern Med. 1984 Jan;100(1):1-6. doi: 10.7326/0003-4819-100-1-1.
A radioreceptor assay for serum 1,25-dihydroxyvitamin D (calcitriol) was used to screen patients with hypercalcemia of malignancy. Three patients with non-Hodgkin's lymphoma and hypercalcemia (serum Ca, 12.0, 13.4, and 13.0 mg/dL, respectively) had increased serum calcitriol levels (56, 72, and 77 pg/mL, respectively; normal, less than 50 pg/mL). Elevated levels of calcitriol, an active vitamin D metabolite, occurred in the presence of significant renal impairment (creatinine clearance, 8 to 19 mL/min) and relative parathyroid suppression (serum immunoreactive parathyroid hormone, 17 to 39 microL-eq/mL; mean value in end-stage renal disease, 182 +/- 39 microL-eq/mL). Hypercalcemia and excessive serum calcitriol levels responded to glucocorticosteroid therapy. In two patients, the hypercalcemia and increased serum calcitriol level were related to a tumor, but not to the serum immunoreactive parathyroid hormone level. Fractional intestinal 47Ca absorption, measured in one patient, was increased (0.94; normal, less than 0.61) and varied directly with the serum calcitriol level. No patient had evidence of sarcoidosis. Hypercalcemia associated with certain lymphomas may be caused by the increased synthesis of calcitriol by lymphoma cells.
采用放射受体分析法检测血清1,25 - 二羟维生素D（骨化三醇），以筛查恶性肿瘤所致高钙血症患者。3例非霍奇金淋巴瘤伴高钙血症患者（血清钙分别为12.0、13.4和13.0mg/dL）血清骨化三醇水平升高（分别为56、72和77pg/mL；正常范围小于50pg/mL）。在存在明显肾功能损害（肌酐清除率8～19mL/min）及相对甲状旁腺抑制（血清免疫反应性甲状旁腺激素17～39μL - eq/mL；终末期肾病平均值为182±39μL - eq/mL）的情况下，活性维生素D代谢产物骨化三醇水平仍升高。高钙血症和血清骨化三醇水平过高对糖皮质激素治疗有反应。在2例患者中，高钙血症和血清骨化三醇水平升高与肿瘤有关，但与血清免疫反应性甲状旁腺激素水平无关。对1例患者测定的肠道47Ca吸收分数增加（0.94；正常范围小于0.61），且与血清骨化三醇水平直接相关。所有患者均无结节病证据。某些淋巴瘤相关的高钙血症可能是由于淋巴瘤细胞合成骨化三醇增加所致。
