Burkhardt E, Kistler H J
Schweiz Med Wochenschr. 1981 Dec 19;111(51):2017-23.
Over a period of 6 1/2 years hypercalcemia has been diagnosed in 86 patients. In 55.8% of cases a malignant tumor was the cause of the elevated calcium levels, and in 22.1% of cases primary hyperparathyroidism (p.Hp.) was diagnosed. In the remaining 19 patients hypercalcemia was related to renal insufficiency (5 patients), vitamin-D intoxication (4) and thiazide therapy (3), while other, rarer causes were identified in 7 cases. As expected, bronchial and breast carcinomas were most frequent (52%) in the malignancy group. In patients below age 40 malignancy was never responsible for the hypercalcemia, but in patients over 50 malignancy was present in 65%. Of the patients with solid tumors 54.8% had skeletal metastases, while other organ metastases were found in 33.3% of these. The occurrence of a hypercalcemia in patients with malignancy is associated with a poor prognosis since over 60% of the patients died within as little as one month and over 90% within a year after the occurrence of hypercalcemia. Renal function impairment in hypercalcemia was significantly more marked in the patients with malignancy than in patients with p.Hp. and was closely related to the calcium levels. Pharmacological reduction of the blood calcium level produced a distinct improvement in renal function in 70% of the patients treated. The current hypothesis on the pathogenesis of hypercalcemia among carcinoma patients is briefly discussed.
在6年半的时间里，86例患者被诊断为高钙血症。在55.8%的病例中，恶性肿瘤是血钙水平升高的原因，22.1%的病例被诊断为原发性甲状旁腺功能亢进（pHp）。其余19例患者的高钙血症与肾功能不全（5例）、维生素D中毒（4例）和噻嗪类药物治疗（3例）有关，7例患者发现了其他罕见原因。正如预期的那样，支气管癌和乳腺癌在恶性肿瘤组中最为常见（52%）。40岁以下的患者中，恶性肿瘤从未导致高钙血症，但50岁以上的患者中，65%存在恶性肿瘤。实体瘤患者中，54.8%有骨转移，其中33.3%有其他器官转移。恶性肿瘤患者发生高钙血症与预后不良有关，因为超过60%的患者在高钙血症发生后短短一个月内死亡，超过90%在一年内死亡。高钙血症患者的肾功能损害在恶性肿瘤患者中比pHp患者更明显，且与血钙水平密切相关。在70%接受治疗的患者中，药物降低血钙水平使肾功能有明显改善。本文简要讨论了目前关于癌症患者高钙血症发病机制的假说。
