title: Survival in hypercalcaemic patients with cancer and co-existing primary hyperparathyroidism.
abstract: Hypercalcaemia associated with malignancy is generally thought to carry a poor prognosis. Of 47 consecutive patients with hypercalcaemia and malignancy, serum parathyroid hormone (PTH) was elevated in seven, consistent with co-existing hyperparathyroidism. Median survival from onset of hypercalcaemia in these seven patients was 817 days; compared to 33 days in the remaining 40 patients with hypercalcaemia of malignancy, in whom PTH was suppressed (p = 0.007). Among patients with hypercalcaemia of malignancy, plasma PTH-related protein (PTHrP) concentration showed no correlation with survival (r2 = 2.1%), but one patient with increased levels of both PTH and PTHrP survived only nine days after the onset of hypercalcaemia. A raised PTH had a positive predictive value of 86% for survival > 100 days, and of 71% for survival > 1 year. A raised plasma PTHrP predicted death within 100 days with a positive predictive value of 69%. We conclude that measurement of serum PTH is indicated in patients with hypercalcaemia and malignancy to identify the 15% with hyperparathyroidism, since this is associated with prolonged survival. In patients with hyperparathyroidism, assay of plasma PTHrP may indicate concurrent hypercalcaemia of malignancy, with an associated poor prognosis.
authors.affiliation: Selly Oak Hospital, Birmingham, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Hutchesson
authors.forename: N J
authors.initials: NJ
authors.lastname: Bundred
authors.forename: W A
authors.initials: WA
authors.lastname: Ratcliffe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology / Q000401:mortality*; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications*; D009363:Neoplasm Proteins / Q000097:blood*; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D010257:Paraneoplastic Syndromes / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D011237:Predictive Value of Tests; D011379:Prognosis; D011506:Proteins / Q000032:analysis*; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D009363:Neoplasm Proteins; C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins