title: Severe hypercalcaemia in B-cell lymphoma: combined effects of PTH-rP, IL-6 and TNF.
abstract: Hypercalcaemia as the only manifestation of B-cell lymphoma is seen very rarely. Its pathophysiology is heterogenous and not well understood. We report a 73-year-old man who presented with severe hypercalcaemia before any signs of malignancy became evident. He was diagnosed with a B-cell lymphoma on bone marrow trephine biopsy. The hypercalcaemia was associated with high plasma concentrations of parathyroid-hormone-related protein, interleukin-6 and tumour necrosis factor. Our patient had markedly increased osteoclast and osteoblast activity as a result of synergistic effects between these factors, with consequent severe hypercalcaemia. This is the first reported example of such combined effects of these factors in humans.
authors.affiliation: Royal Liverpool University Hospital, UK.
authors.forename: A
authors.initials: A
authors.lastname: Daroszewska
authors.forename: R C
authors.initials: RC
authors.lastname: Bucknall
authors.forename: P
authors.initials: P
authors.lastname: Chu
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001854:Bone Marrow Cells; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism*; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D009363:Neoplasm Proteins / Q000378:metabolism*; D010006:Osteoblasts / Q000473:pathology; D010010:Osteoclasts / Q000473:pathology; D044162:Parathyroid Hormone-Related Protein; D011241:Prednisone / Q000008:administration & dosage; D011506:Proteins / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D015850:Interleukin-6; D009363:Neoplasm Proteins; C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D014409:Tumor Necrosis Factor-alpha; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D011241:Prednisone