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.
Department of Biochemistry, National Kyushu Cancer Center, Fukuoka, Japan. highuchi@nk-cc.go.jp
H
H
Iguchi
C
C
Miyagi
K
K
Tomita
S
S
Kawauchi
Y
Y
Nozuka
M
M
Tsuneyoshi
H
H
Wakasugi
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