Hypercalcemia caused by ectopic production of parathyroid hormone in a patient with papillary adenocarcinoma of the thyroid gland.
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.
Iguchi
H
H
Department of Biochemistry, National Kyushu Cancer Center, Fukuoka, Japan. highuchi@nk-cc.go.jp
Miyagi
C
C
Tomita
K
K
Kawauchi
S
S
Nozuka
Y
Y
Tsuneyoshi
M
M
Wakasugi
H
H
D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery; D009384:Paraneoplastic Endocrine Syndromes / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D010281:Parathyroid Hormone / Q000096:biosynthesis / Q000378:metabolism*; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D010281:Parathyroid Hormone