title: A case of myeloma with hypercalcemia caused by high serum concentrations of both parathyroid hormone-related peptide (PTHrP) and macrophage inflammatory protein-1α (MIP-1α).
abstract: A 62-year-old woman was admitted with dry mouth, general fatigue, and severe back pain. Biochemistry examination showed extreme hypercalcemia (21.2 mg/dL). Bone marrow examination was negative, but needle biopsy of a metastatic lung tumor revealed abnormal plasma cells; thus, multiple myeloma stage III-A was finally diagnosed. Serum concentrations of both parathyroid hormone-related peptide (PTHrP) and macrophage inflammatory protein-1α (MIP-1α) were markedly elevated (PTHrP 7.2 pmol/L, normal <1.1 pmol/L; MIP-1α 84.9 pg/mL, normal <46.9 pg/mL). Her myeloma appeared to have simultaneously caused two mechanisms producing hypercalcemia: humoral hypercalcemia of malignancy (HHM) by PTHrP and local osteolytic hypercalcemia (LOH) by MIP-1α. Therefore, the combination of two calcium-modulating abnormalities likely aggravated her hypercalcemia.
authors.affiliation: Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan. shimizuh@dokkyomed.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Monden
authors.forename: Takanori
authors.initials: T
authors.lastname: Tomotsune
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Nozomi
authors.initials: N
authors.lastname: Domeki
authors.forename: Mihoko
authors.initials: M
authors.lastname: Matsumura
authors.forename: Teruo
authors.initials: T
authors.lastname: Jojima
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawagoe
authors.forename: Kikuo
authors.initials: K
authors.lastname: Kasai
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002116:Calcitonin / Q000008:administration & dosage; D002118:Calcium / Q000097:blood; D054405:Chemokine CCL3 / Q000097:blood*; D003907:Dexamethasone / Q000008:administration & dosage; D004164:Diphosphonates / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood* / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000077268:Pamidronate; D044162:Parathyroid Hormone-Related Protein / Q000097:blood*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; C515429:CCL3 protein, human; D054405:Chemokine CCL3; D004164:Diphosphonates; D044162:Parathyroid Hormone-Related Protein; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D002116:Calcitonin; D000077268:Pamidronate; D002118:Calcium