Humoral Hypercalcemia of Malignancy Associated with Parathyroid Hormone-Related Protein Producing Transitional Cell Carcinoma of the Ureter.

Abstract

A 78-year old male with ureteral carcinoma manifesting hypercalcemia is reported. He was diagnosed as having ureteral carcinoma of the left side 2 years previously and was treated by nephrectomy with ureterovesicostomy. In October 1991, he was admitted for anorexia. A clinical examination revealed recurrence of the ureteral carcinoma with metastasis to the rectum and liver. His serum calcium level was elevated (13.9 mg/dl). In addition to rehydration and furosemide, treatment with eel-calcitonin and prednisolone failed to decrease his serum calcium level. Finally, he was administered mithramycin but he died 13 days later. He had no evidence of bone metastasis or hyperparathyroidism. Nephrogenic CAMPand urinary parathyroid hormone-related protein (PTHrP) were markedly elevated. Immunohistochemical study demonstrated expression ofPTHrP in the tumor cells. Thus, the hypercalcemia was thought to be mediated by PTHrPsecreted from the neoplastic tumor. Although there have been several reports of ureteral carcinoma associated with humoral hypercalcemia of malignancy, this is considered to be the first case associated with elevation of PTHrP. (Internal Medicine 33: 107-109, 1994)

Hypercalcemia associated with lymph node metastasis following radical cystectomy for bladder cancer

“…PTHrP, which is structurally similar to PTH, is considered a humoral factor for hypercalcemia and one of the main mechanisms underlying hypercalcemia associated with malignancy without bone metastasis. 1,7,8 Indeed, we affirmed the existence of PTHrP in cancer cell cytoplasm of squamous differentiated UC in the present case, although his serum PTHrP level was not measured. PTHrP can enhance the renal tubular reabsorption of calcium while simultaneously increasing urinary phosphorus excretion and the RANKL secretion due to the stimulation of osteoblasts.…”

“…Additionally, hemodialysis may be considered for severe hypercalcemia. PTHrP, which is structurally similar to PTH, is considered a humoral factor for hypercalcemia and one of the main mechanisms underlying hypercalcemia associated with malignancy without bone metastasis . Indeed, we affirmed the existence of PTHrP in cancer cell cytoplasm of squamous differentiated UC in the present case, although his serum PTHrP level was not measured.…”

Regulation of Granulocyte Colony‐stimulating Factor and Parathyroid Hormonerelated Protein Production in Lung Carcinoma Cell Line OKa‐C‐1

“…[1][2][3][4][5][6][7][8][9][10] The production of granulocyte colony-stimulating factor (G-CSF) or parathyroid hormone-related protein (PTHrP) by cancer cells is thought to be responsible for these paraneoplastic syndromes. [11][12][13][14][15][16] However, it remains unknown whether simultaneous occurrence of hypercalcemia and leukocytosis is coincidental or not.…”