Iguchi H, Miyagi C, Tomita K, Kawauchi S, Nozuka Y, Tsuneyoshi M, Wakasugi H
Department of Biochemistry, National Kyushu Cancer Center, Fukuoka, Japan.
J Clin Endocrinol Metab. 1998 Aug;83(8):2653-7. doi: 10.1210/jcem.83.8.5025.
Hypercalcemia and elevation of a serum PTH level (9800 pg/mL (normal: 160-520) were found in a 72-yr-old woman who had a lung cancer. She underwent pulmonary lobectomy for a suspected PTH-producing lung cancer. However, hypercalcemia and elevation of the serum PTH level were persistent postoperatively. Subsequent examination, using parathyroid scintiscanning, revealed a hot spot in the right lower part of the thyroid gland, suggesting hypercalcemia caused by a parathyroid tumor. She underwent bilateral exploration of the neck; however, four apparently normal parathyroid glands were seen. Therefore, hemithyroidectomy was performed for the possibility of an intrathyroidal parathyroid adenoma. Serum calcium and PTH levels declined after this operation. A nodular lesion was found in the cut sections of the resected specimen, which was consistent with the result of the scintiscanning. Histological examinations revealed a papillary adenocarcinoma of the thyroid gland, and the PTH-immunoreactivity in the tumor cells was confirmed. These findings strongly suggest that PTH could be produced ectopically by the papillary adenocarcinoma of the thyroid gland.
一名72岁患肺癌的女性被发现有高钙血症且血清甲状旁腺激素水平升高（9800 pg/mL，正常范围：160 - 520）。她因疑似产生甲状旁腺激素的肺癌接受了肺叶切除术。然而，术后高钙血症和血清甲状旁腺激素水平仍持续存在。随后，通过甲状旁腺闪烁扫描检查发现甲状腺右下部有一个热点，提示高钙血症是由甲状旁腺肿瘤引起的。她接受了双侧颈部探查；然而，发现四个甲状旁腺外观正常。因此，鉴于存在甲状腺内甲状旁腺腺瘤的可能性，进行了甲状腺半切除术。该手术后血清钙和甲状旁腺激素水平下降。在切除标本的切片中发现一个结节性病变，这与闪烁扫描结果一致。组织学检查显示为甲状腺乳头状腺癌，并证实肿瘤细胞中有甲状旁腺激素免疫反应性。这些发现强烈提示甲状旁腺激素可能由甲状腺乳头状腺癌异位产生。
