We discussed a case of hypercalcemia this morning and reviewed the mechanisms by which malignancy can cause hypercalcemia.
1. Direct metastases to bone: These mets trigger the production of inflammatory cytokines and stimulate ostoclasts. Sometimes osteoclasts are directly stimulated by tumor cells via Osteoclast Activating Factors (eg IL6) in multiple myeloma or lymphoma.
2. PTH related peptide: this is the most common cause of hypercalcemia from non-metastatic solid tumors. Classically in squamous cell lung Ca
3. PTH: this is rare! only a few case reports of PTH being released from tumors
4. Calcitriol: a very common mechanism for hypercalcemia in the lymphomas.
Here is a great review article.
*CT scan of a patient presenting with Ca=3.1, who subsequently was found to hav have small cell lung cancer.
2 comments :
Glad to see the blog still running strong.
Came across a cute case report of hypercalcemia from an atypical cause of calcitriol production which is a valuable teaching case from a number of reasons:
www.nejm.org/doi/full/10.1056/NEJM200001063420107
-Todd
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