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Related Experiment Videos

Primary hyperparathyroidism or hypercalcaemia of malignancy?

K I Birkeland1, F Gallefoss, S Olsson

  • 1Hormone Laboratory, Aker Hospital, Oslo, Norway.

Scandinavian Journal of Clinical and Laboratory Investigation
|June 1, 1992
PubMed
Summary

Recurrent hypercalcaemia in a patient previously treated for primary hyperparathyroidism was linked to elevated parathyroid hormone-related peptide (PTH-RP), suggesting malignancy. Autopsy confirmed pancreatic adenocarcinoma, highlighting PTH-RP

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Area of Science:

  • Endocrinology
  • Oncology
  • Clinical Diagnostics

Background:

  • Two-site immunometric assays for intact parathyroid hormone (PTH) and radioimmunoassays for PTH-related peptide (PTH-RP) aid hypercalcaemia evaluation.
  • Primary hyperparathyroidism is a common cause of hypercalcaemia, often treated surgically.

Observation:

  • A 63-year-old man presented with recurrent hypercalcaemia 3 years post-surgery for primary hyperparathyroidism.
  • Mid-region PTH assays showed normal levels, similar to his primary hyperparathyroidism state.
  • Intact PTH levels were suppressed, while PTH-RP levels were significantly elevated.

Findings:

  • The discrepant PTH and elevated PTH-RP levels suggested humoral hypercalcaemia of malignancy.
  • The patient's condition led to death within 2 months.

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  • Autopsy revealed pancreatic adenocarcinoma without skeletal metastases.

    • Implications:

    • This case underscores the utility of PTH-RP assays in diagnosing malignancy-associated hypercalcaemia, especially when intact PTH is suppressed.
    • It highlights the importance of considering humoral hypercalcaemia of malignancy in patients with recurrent hypercalcaemia.
    • Accurate diagnostic assays are crucial for differentiating causes of hypercalcaemia and guiding patient management.