title: Coincidental occurrence of primary hyperparathyroidism and cancer-associated hypercalcaemia in a middle-aged man.
abstract: 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.
authors.affiliation: University Department of Medicine, Glasgow Royal Infirmary.
authors.forename: S J
authors.initials: SJ
authors.lastname: Gallacher
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
authors.forename: M A
authors.initials: MA
authors.lastname: Farquharson
authors.forename: F C
authors.initials: FC
authors.lastname: Logue
authors.forename: C
authors.initials: C
authors.lastname: McArdle
authors.forename: I T
authors.initials: IT
authors.lastname: Boyle
authors.forename: E R
authors.initials: ER
authors.lastname: Nairn
authors.forename: A M
authors.initials: AM
authors.lastname: McNicol
mesh_terms: D001859:Bone Neoplasms / Q000097:blood / Q000473:pathology / Q000556:secondary*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications* / Q000473:pathology; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D009382:Neoplasms, Unknown Primary / Q000097:blood / Q000150:complications* / Q000473:pathology; D010280:Parathyroid Glands / Q000473:pathology; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000032:analysis; D013249:Sternum
chemical_list: D009363:Neoplasm Proteins; C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins