Lung cancer associated with hypercalcemia induced by concurrently elevated parathyroid hormone and parathyroid hormone-related protein levels.
In general, many cases of malignancy-associated hypercalcemia are due to HHM. In patients with humoral hypercalcemia of malignancy (HHM), it has been reported that plasma parathyroid hormone-related protein (PTHrP) and cyclic adenosine monophosphate (cAMP) levels were elevated, while plasma PTH and active vitamin D(3) levels were suppressed. Our patient showed hypercalcemia with a concurrent increase in plasma and tumor tissue PTHrP and PTH concentrations and also high cAMP and low 1-25(OH)(2)VD(3) levels in the plasma. These data suggest that the hypercalcemia exhibited by our patient was consistent with HHM due to lung cancer and its liver metastasis. Moreover, diagnostic imaging and autopsy findings showed no appreciable lesions of the parathyroid gland. In addition, histopathologic examination of the primary and metastatic tumors revealed the existence of PTH immunohistochemically stained with anti-PTH antibodies, suggesting an ectopic-PTH-producing lung tumor. From these data, our patient was diagnosed with a rare case of lung cancer, which produced both ectopic PTH and PTHrP.
Uchimura
Keiko
K
Division of Endocrinology and Metabolism, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Mokuno
Takehiko
T
Nagasaka
Akio
A
Hayakawa
Nobuki
N
Kato
Taiya
T
Yamazaki
Naho
N
Kobayashi
Takako
T
Nagata
Mutsuko
M
Kotake
Motoko
M
Itoh
Mitsuyasu
M
Tsujimura
Toru
T
Iwase
Katsumi
K
D000368:Aged; D002118:Calcium / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D017809:Fatal Outcome; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D007150:Immunohistochemistry; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000556:secondary*; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000032:analysis / Q000378:metabolism*; D011859:Radiography; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D002118:Calcium