Gallacher S J, Fraser W D, Farquharson M A, Logue F C, McArdle C, Boyle I T, Nairn E R, McNicol A M
University Department of Medicine, Glasgow Royal Infirmary.
Clin Endocrinol (Oxf). 1993 Apr;38(4):433-7. doi: 10.1111/j.1365-2265.1993.tb00526.x.
Primary hyperparathyroidism (PHPT) is found not uncommonly in patients with cancer. In this report, however, we describe a patient where both humoral hypercalcaemia of malignancy and PHPT were present coincidentally. A 47-year-old man was found to have PHPT due to parathyroid hyperplasia. Serum parathyroid hormone (PTH) levels, which were elevated before parathyroidectomy, were undetectable post-operatively; however, hypercalcaemia persisted. Nephrogenous cyclic adenosine monophosphate was elevated along with this undetectable PTH, indicative of the presence of a PTH-like factor in the serum. This was confirmed by the finding of an elevated level of PTH-related protein (PTHrP) in plasma (9.1 pmol/l, normal < 2.6 pmol/l). Secondary carcinoma was identified in a lesion in the region of the manubrium sternii. This stained positively for PTHrP by immunocytochemistry and PTHrP messenger RNA was detected by in-situ hybridization. This case illustrates the value of sensitive PTH assays in distinguishing PHPT from other causes of hypercalcaemia and also shows the importance of considering primary hyperparathyroidism in the differential diagnosis of the patient with cancer and hypercalcaemia.
原发性甲状旁腺功能亢进症（PHPT）在癌症患者中并不罕见。然而，在本报告中，我们描述了一名同时存在恶性肿瘤体液性高钙血症和PHPT的患者。一名47岁男性因甲状旁腺增生被诊断为PHPT。甲状旁腺切除术前血清甲状旁腺激素（PTH）水平升高，术后检测不到；然而，高钙血症持续存在。肾源性环磷酸腺苷随着不可检测的PTH升高，表明血清中存在PTH样因子。血浆中PTH相关蛋白（PTHrP）水平升高（9.1 pmol/l，正常<2.6 pmol/l）证实了这一点。在胸骨柄区域的一个病变中发现了继发性癌。通过免疫细胞化学检测该病变PTHrP呈阳性，原位杂交检测到PTHrP信使核糖核酸。该病例说明了敏感PTH检测在区分PHPT与其他高钙血症病因方面的价值，也显示了在癌症和高钙血症患者的鉴别诊断中考虑原发性甲状旁腺功能亢进症的重要性。
