title: Humoral hypercalcemia associated with gastric carcinoma secreting parathyroid hormone: a case report and review of the literature.
abstract: Hypercalcemia with concomitant elevation of serum parathyroid hormone (PTH) and PTH-related protein (PTHrP) levels was found in a patient with advanced gastric carcinoma and multiple liver metastases. The most common features are hypercalcemia associated with hypersecretion of PTHrP and physiological suppression of PTH secretion in the syndrome of humoral hypercalcemia of malignancy (HHM). Although we initially made a diagnosis of primary hyperparathyroidism concomitant with HHM due to gastric cancer, diagnostic imaging studies, such as echography, CT, sestamibi scintigraphy, and autopsy findings, did not reveal evidence of any parathyroid tumors or ectopic parathyroid glands in the mediastinum. Both primary and metastatic tumor cells showed positive staining with PTH-specific antibody as well as PTHrP-specific antibody on immunohistochemical examination. PTH concentration in the cytosolic fraction of the metastatic tumor was elevated compared to that from a control patient with no calcium metabolic disorders in vitro. These findings indicated that PTH secreted ectopically by gastric cancer cells, not by parathyroid glands, caused hypercalcemia in this patient. To our knowledge, this is the first case report of PTH-secreting gastric carcinoma cells. We report the case and a review of the previous reported PTH-secreting non-parathyroid tumors along with the mechanisms of secretion.
authors.affiliation: Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan. 0463@imh.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Nakajima
authors.forename: Masataka
authors.initials: M
authors.lastname: Tamai
authors.forename: Shinji
authors.initials: S
authors.lastname: Okaniwa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Mutsuhiro
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Niwa
authors.forename: Naoto
authors.initials: N
authors.lastname: Horigome
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ito
authors.forename: Satoru
authors.initials: S
authors.lastname: Suzuki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishio
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Komatsu
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology / Q000556:secondary; D003600:Cytosol / Q000378:metabolism; D017809:Fatal Outcome; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D010257:Paraneoplastic Syndromes / Q000209:etiology*; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D044162:Parathyroid Hormone-Related Protein / Q000097:blood / Q000378:metabolism; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology
chemical_list: C470125:PTH protein, human; C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein