Ectopic secretion of parathyroid hormone by a renal adenocarcinoma in a patient with hypercalcaemia.

Abstract

Medical MemorandaMIDALeJOUWNL keratodermia spread to involve all four limbs, the back, the face, and the scalp. The lesions progressed from a macular eruption to vesicular and pustular stages, finally becoming hard scaling keratotic plaques, which on the feet were painful and irritating. Fresh lesions appeared adjacent to areas of healing ( Fig. 1), and in view of their severity oral prednisone 40 mg. daily and topical hydrocortisone were prescribed. The arthritis was also treated with indomethacin with partial relief, but after a few days of steroid therapy her pyrexia subsided, joint pains were further relieved, and there was a noticeable improvement in the skin lesions. After 11 weeks in hospital she was discharged, the prednisone being gradually reduced. At the time of this report no fresh skin or mucosal lesions had appeared, and repeat radiographs of the hands, the feet, and sacroiliac joints were normal. Histological examination of involved skin ( Fig. 2) showed spongiform pustules in the upper epidermis, acanthosis, infiltration with polymorphs, and hyperkeratosis. The underlying dermis showed mild perivascular chronic inflammatory cell infiltration. (Hancock, 1960) and are painless and superficial. The mucous membrane lesions usually precede the skin lesions and may also occur before the onset of arthritis (Nicol, 1966). It is likely that the oral lesions in this patient were present on admission but were overlooked, for when the diagnosis of Reiter's disease became obvious with the eruption of keratodernia blennorrhagica, closer inspection of the tongue showed lesions practically healed. An extremely rare feature in this case was that the keratodermia involved the face. Though lesions of the scalp may extend a little on to the forehead (King, 1964), facial involvement in Reiteres disease is practically never seen (Oates, 1970).Treatment of Reiter's disease with steroids is not indicated unless the illness is severe. In the present case the administration of prednisone resulted in cessation of pyrexia for the first time since admission, healing of skin lesions, and a shortened stay in hospital.I should like to thank Professor M. D. Milne, Westminster

Hypercalcemia Associated with an Adenocarcinoma Derived from the Apocrine Glands of the Anal Sac

“…Secondly, the level of hormone secreted may be low enough that a large mass of neoplastic tissue is necessary for detection of biologic activity. In support of the latter explanation is the observation that the parathyroid hormone content of malignant neoplasms in people with pseudohyperparathyroidism has ranged from only 0.75 to 8.9 pg per gram dry weight [5,16,23,44] as compared to 200 to 600 pg per gram dry weight in normal and adenomatous parathyroid tissue [20,44].…”

Paraneoplastic Syndromes in Patients with Urological Malignancies

“…However, nonparaneoplastic, bone metastasis-related hypercalcemia is also highly prevalent among RCC patients. Of those with hypercalcemia and RCC, approximately 75% have high-stage lesions and 50% bone metastasis [4,5] , although neither the presence nor degree of hypercalcemia has been shown to have a significant correlation with tumor grade or survival [6] .…”

“…Occasionally reported in association with bladder urothelial carcinoma (BCa) [3] , HHM is the most common PNS among patients with RCC, affecting between 13 and 20% of patients [4] . However, nonparaneoplastic, bone metastasis-related hypercalcemia is also highly prevalent among RCC patients.…”

Parathyroid Hormone‐related Protein in Hypercalcaemia of Malignancy

“…The first direct support for this came from the first PTH radioimmunoassay, when Berson and Yalow (1966) found significantly elevated PTH levels in an unselected group of patients with bronchogenic carcinoma. There were subsequently several reports of measurement of PTH by radioimmunoassay in plasma or extracts of cancers from patients with this syndrome (Sherwood et al, 1967;Melick et al, 1972;Buckle et al, 1970), of an arteriovenous gradient of PTH across a tumour bed (Knill-Jones et al, 1970), and we showed that a cell culture established from a renal cortical carcinoma of a hypercalcaemia patient produced immunoreactive PTH (Greenberg et al, 1973). In none of these instances, however, was the circulating level of PTH as high as frequently found in patients with primary hyperparathyroidism and comparable degrees of elevated plasma calcium.…”