title: Contribution of parathyroid hormone-related peptide to the evaluation of hypercalcemia.
abstract: Hypercalcemia of malignancy is due either to local osteolysis at the site of bone metastases or to production by the malignancy of parathyroid hormone-related peptide, which shares some of the effects of parathyroid hormone. We used a radioimmunoassay (antiserum specific to the amino-terminus) to measure serum parathyroid hormone-related peptide levels in controls (n = 61), chronic renal failure patients (n = 10), patients with primary hyperparathyroidism (n = 19), cancer patients with (n = 35) or without (n = 57) hypercalcemia and/or bone metastases (n = 53 and n = 39, respectively), and patients with hematologic malignancies (n = 15). We set the upper limit of normal of the parathyroid hormone-related peptide assay at 2.7 pmol/L. The peptide was undetectable in two-thirds of healthy controls. Renal failure did not interfere with the assay. Eighteen of the 19 patients with primary hyperparathyroidism had normal levels. In contrast, 82% of patients with humoral hypercalcemia of malignancy (i.e., without detectable bone metastases) had increased levels; in this subgroup there was a significant inverse correlation between serum levels of the peptide and phosphorus. Elevation of parathyroid hormone-related peptide levels was less common among hypercalcemic patients with metastatic bone disease (38%). Four of the seven hypercalcemic patients with hematologic malignancies had elevated parathyroid hormone-related peptide levels. In our overall study population, serum calcium levels were weakly but significantly correlated with parathyroid hormone-related peptide levels. In conclusion, elevated parathyroid hormone-related peptide in a patient with hypercalcemia suggests a malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Rheumatology, Angers Teaching Hospital, France.
authors.forename: M
authors.initials: M
authors.lastname: Audran
authors.forename: A
authors.initials: A
authors.lastname: Minebois-Villégas
authors.forename: A
authors.initials: A
authors.lastname: Lortholary
authors.forename: E
authors.initials: E
authors.lastname: Legrand
authors.forename: C
authors.initials: C
authors.lastname: Pascaretti
authors.forename: P
authors.initials: P
authors.lastname: Giraud
authors.forename: J F
authors.initials: JF
authors.lastname: Subra
authors.forename: M
authors.initials: M
authors.lastname: Boasson
authors.forename: P
authors.initials: P
authors.lastname: Jallet
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000097:blood / Q000556:secondary; D002118:Calcium / Q000097:blood; D005260:Female; D006402:Hematologic Diseases / Q000097:blood; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006961:Hyperparathyroidism / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000032:analysis*; D011863:Radioimmunoassay; D012016:Reference Values
chemical_list: C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D002118:Calcium