title: Lung cancer associated with hypercalcemia induced by concurrently elevated parathyroid hormone and parathyroid hormone-related protein levels.
abstract: 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.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Uchimura
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mokuno
authors.forename: Akio
authors.initials: A
authors.lastname: Nagasaka
authors.forename: Nobuki
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Taiya
authors.initials: T
authors.lastname: Kato
authors.forename: Naho
authors.initials: N
authors.lastname: Yamazaki
authors.forename: Takako
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Nagata
authors.forename: Motoko
authors.initials: M
authors.lastname: Kotake
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Itoh
authors.forename: Toru
authors.initials: T
authors.lastname: Tsujimura
authors.forename: Katsumi
authors.initials: K
authors.lastname: Iwase
mesh_terms: 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
chemical_list: C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D002118:Calcium