Walls J, Bundred N, Howell A
Department of Surgery, Northern General Hospital, Sheffield, England.
Clin Orthop Relat Res. 1995 Mar(312):51-63.
Hypercalcemia is the most common paraneoplastic syndrome associated with cancer. This paper addresses the etiology and pathogenesis of hypercalcemia of malignancy and discusses the relative contributions of local and humoral effects on bone and renal calcium homeostasis. The roles of parathyroid hormone-related protein and other osteolytic cytokines are outlined. New biochemical markers that enable more specific monitoring of the response of bone metastases to treatment are introduced, including urinary excretion of the collagen crosslinks pyridinoline and deoxypyridinoline. The clinical management and prevention of hypercalcemia is systemically outlined, including indications for bisphosphonate, glucocorticoid, and calcitonin therapy. The results of recent trials of bisphosphonate therapy for the prevention of tumor progression and its subsequent problems such as bone pain, fracture, and hypercalcemia also are discussed.
高钙血症是与癌症相关的最常见副肿瘤综合征。本文阐述了恶性肿瘤高钙血症的病因和发病机制，并讨论了局部和体液因素对骨和肾钙稳态的相对影响。概述了甲状旁腺激素相关蛋白和其他溶骨细胞因子的作用。介绍了能够更特异性监测骨转移对治疗反应的新生化标志物，包括胶原交联物吡啶啉和脱氧吡啶啉的尿排泄量。系统概述了高钙血症的临床管理和预防，包括双膦酸盐、糖皮质激素和降钙素治疗的适应证。还讨论了双膦酸盐治疗预防肿瘤进展及其后续问题（如骨痛、骨折和高钙血症）的近期试验结果。
