Primary hyperparathyroidism or hypercalcaemia of malignancy?
The introduction of two-site immunometric assays measuring intact parathyroid hormone (PTH) and radioimmunoassays measuring PTH-related peptide (PTH-RP) have simplified the evaluation of patients with hypercalcaemia. We present a 63-year-old man with recurrent hypercalcaemia after surgical treatment for primary hyperparathyroidism 3 years previously. PTH measured with a mid-region radioimmunoassay gave normal values, at the same level as during his primary hyperparathyroidism. Intact PTH was, however, clearly suppressed, and he had a highly elevated level of PTH-RP. This suggested that he had humoral hypercalcaemia of malignancy. The patient died after 2 months, and at autopsy an adenocarcinoma of the pancreas with no skeletal metastases was found.
Birkeland
K I
KI
Hormone Laboratory, Aker Hospital, Oslo, Norway.
Gallefoss
F
F
Olsson
S
S
Haug
E
E
D000230:Adenocarcinoma / Q000150:complications; D003937:Diagnosis, Differential; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006961:Hyperparathyroidism / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000378:metabolism
C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins