Diagnostic approach to hypercalcemia: relevance of parathyroid hormone and parathyroid hormone-related protein measurements

摘要: Background: Parathyroid hormone (PTH) and parathyroid hormone-related protein (PTH-rP) are two potent hypercalcemic hormones that act on the same targets. Autonomous secretion of former is involved in primary hyperparathyroidism (PHPT), whereas latter responsible for humoral hypercalcemia malignancy (HHM). Methods: From 250 consecutive, serum samples sent to our laboratory assessment intact PTH, we were able obtain clinical information, as well an additional plasma sample PTH-rP measurement, 134 patients. At time sampling, patients could be classified into seven groups: cancer without known bone metastases (CaNoMeta, n=36), with (CaMeta, n=9), no evidence (noEvCa, n=71), sarcoidosis (Sarc, n=3), end-stage renal disease (ESRD, n=12), vitamin D overdose (VIT-D, n=2), hyperthyroidism (Thyr, n=1). Results: In CaNoMeta group, 29/36 had elevated levels, 9/36 inappropriately PTH 5/36 levels both hormones. CaMeta three nine them concomitantly levels. NoEvCa 63/71 inappropriate elevation diagnosed having PHPT. Four 71 PTH-rP; poor health died within a short period time. All ESRD very high normal except one woman undetectable levels; she from what later turned out recurrent bladder carcinoma. Sarc, Vit-D, Thyr groups, normal. Conclusions: (1) Elevated common finding metastases. Intact however, should always measured because concurrent not rare. (2) Primary accounts 90% whose may also found few cases, even some surgically demonstrated adenoma.