Humoral hypercalcemia associated with gastric carcinoma secreting parathyroid hormone: a case report and review of the literature

Koji Nakajima; Masataka Tamai; Shinji Okaniwa; Yoshiyuki Nakamura; Mutsuhiro Kobayashi; Tomohiro Niwa; Naoto Horigome; Nobuo Ito; Satoru Suzuki; Shinichi Nishio; Mitsuhisa Komatsu

doi:10.1507/endocrj.EJ12-0406

ORIGINALS

Humoral hypercalcemia associated with gastric carcinoma secreting parathyroid hormone: a case report and review of the literature

Koji Nakajima, Masataka Tamai, Shinji Okaniwa, Yoshiyuki Nakamura, Mutsuhiro Kobayashi, Tomohiro Niwa, Naoto Horigome, Nobuo Ito, Satoru Suzuki, Shinichi Nishio, Mitsuhisa Komatsu

Author information

Koji Nakajima
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Masataka Tamai
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Shinji Okaniwa
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Yoshiyuki Nakamura
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Mutsuhiro Kobayashi
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Tomohiro Niwa
Department of Internal Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
Naoto Horigome
Department of Surgery, Iida Municipal Hospital, Iida 395-8502, Japan
Nobuo Ito
Department of Clinical Pathology, Iida Municipal Hospital, Iida 395-8502, Japan
Satoru Suzuki
Department of Aging and Geriatrics, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
Shinichi Nishio
Department of Aging and Geriatrics, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
Mitsuhisa Komatsu
Department of Aging and Geriatrics, Shinshu University School of Medicine, Matsumoto 390-8621, Japan

Keywords: Humoral hypercalcemia of malignancy (HHM), Parathyroid hormone, Gastric carcinoma, Immunohistochemistry, Cytosolic fraction

JOURNAL FREE ACCESS

2013 Volume 60 Issue 5 Pages 557-562

DOI https://doi.org/10.1507/endocrj.EJ12-0406

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Details

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.

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