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Coincidental occurrence of primary hyperparathyroidism and cancer‐associated hypercalcaemia in a middle‐aged man
Author(s) -
Gallacher S. J.,
Fraser W. D.,
Farquharson M. A.,
Logue F. C.,
McArdle C.,
Boyle I. T.,
Nairn E. R.,
McNicol A. M.
Publication year - 1993
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1993.tb00526.x
Subject(s) - hypercalcaemia , primary hyperparathyroidism , medicine , endocrinology , parathyroid hormone , parathyroidectomy , malignancy , hyperparathyroidism , parathyroid hormone related protein , calcium
Summary Primary hyperparathyroidism (PHPT) is found not uncommonly in patients with cancer. In this report, however, we describe a patient where both humoral hypercalcaemia of malignancy and PHPT were present coincidentally. A 47‐year‐old man was found to have PHPT due to parathyroid hyperplasia. Serum parathyroid hormone (PTH) levels, which were elevated before parathyroidectomy, were undetectable post‐operatively; however, hypercalcaemia persisted. Nephrogenous cyclic adenosine monophosphate was elevated along with this undetectable PTH, indicative of the presence of a PTH‐like factor in the serum. This was confirmed by the finding of an elevated level of PTH‐related protein (PTH r P) in plasma (91 pmol/l, normal <2.6 pmoI/I). Secondary carcinoma was identified in a lesion in the region of the manubrium sternii. This stained positively for PTH r P by immunocyto‐chemistry and PTH r P messenger RNA was detected by insitu hybridization. This case illustrates the value of sensitive PTH assays in distinguishing PHPT from other causes of hypercalcaemia and also shows the importance of considering primary hyperparathyroidism in the differential diagnosis of the patient with cancer and hypercalcaemia.