A Case of Myeloma with Hypercalcemia Caused by High Serum Concentrations of both Parathyroid Hormone-related Peptide (PTHrP) and Macrophage Inflammatory Protein-1α (MIP-1α)

Hiroaki Shimizu; Tsuyoshi Monden; Takanori Tomotsune; Yuki Nakatani; Nozomi Domeki; Mihoko Matsumura; Teruo Jojima; Yoshiaki Kawagoe; Kikuo Kasai

doi:10.2169/internalmedicine.50.6096

CASE REPORTS

A Case of Myeloma with Hypercalcemia Caused by High Serum Concentrations of both Parathyroid Hormone-related Peptide (PTHrP) and Macrophage Inflammatory Protein-1α (MIP-1α)

Hiroaki Shimizu, Tsuyoshi Monden, Takanori Tomotsune, Yuki Nakatani, Nozomi Domeki, Mihoko Matsumura, Teruo Jojima, Yoshiaki Kawagoe, Kikuo Kasai

Author information

Hiroaki Shimizu
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Tsuyoshi Monden
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Takanori Tomotsune
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Yuki Nakatani
Department of Diabetes & Endocrinology, Dokkyo Medical University Nikko Medical Center, Japan
Nozomi Domeki
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Mihoko Matsumura
Department of Internal Medicine, Tochigi Medical Association Shiobara Onsen Hospital, Japan
Teruo Jojima
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Yoshiaki Kawagoe
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan
Kikuo Kasai
Department of Endocrinology & Metabolism, Dokkyo Medical University, Japan

Keywords: humoral hypercalcemia of malignancy, local osteolytic hypercalcemia, macrophage inflammatory protein-1α, parathyroid hormone-related peptide

JOURNAL OPEN ACCESS

2011 Volume 50 Issue 24 Pages 2993-2996

DOI https://doi.org/10.2169/internalmedicine.50.6096

Details

Abstract

A 62-year-old woman was admitted with dry mouth, general fatigue, and severe back pain. Biochemistry examination showed extreme hypercalcemia (21.2 mg/dL). Bone marrow examination was negative, but needle biopsy of a metastatic lung tumor revealed abnormal plasma cells; thus, multiple myeloma stage III-A was finally diagnosed. Serum concentrations of both parathyroid hormone-related peptide (PTHrP) and macrophage inflammatory protein-1α (MIP-1α) were markedly elevated (PTHrP 7.2 pmol/L, normal <1.1 pmol/L; MIP-1α 84.9 pg/mL, normal <46.9 pg/mL). Her myeloma appeared to have simultaneously caused two mechanisms producing hypercalcemia: humoral hypercalcemia of malignancy (HHM) by PTHrP and local osteolytic hypercalcemia (LOH) by MIP-1α. Therefore, the combination of two calcium-modulating abnormalities likely aggravated her hypercalcemia.

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