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Hypercalcemia Caused by Ectopic Production of Parathyroid Hormone in a Patient with Papillary Adenocarcinoma of the Thyroid Gland

Department of Biochemistry (H.I.), Division of Head and Neck Surgery (C.M., K.T.), Department of Pathology (S.K.), Division of Gastroenterology (H.W.), National Kyusyu Cancer Center, Second Department of Pathology, Faculty of Medicine, Kyusyu University (Y.N., M.T.), Fukuoka 815, Japan

Address all correspondence and requests for reprints to: Haruo Iguchi, Department of Biochemistry, National Kyusyu Cancer Center, Notame 3–1-1, Minami-ku, Fukuoka 815, Japan. E-mail: highuchi{at}nk-cc.go.jp

Hypercalcemia and elevation of a serum PTH level (9800 pg/mL (normal: 160–520) were found in a 72-yr-old woman who had a lung cancer. She underwent pulmonary lobectomy for a suspected PTH-producing lung cancer. However, hypercalcemia and elevation of the serum PTH level were persistent postoperatively. Subsequent examination, using parathyroid scintiscanning, revealed a hot spot in the right lower part of the thyroid gland, suggesting hypercalcemia caused by a parathyroid tumor. She underwent bilateral exploration of the neck; however, four apparently normal parathyroid glands were seen. Therefore, hemithyroidectomy was performed for the possibility of an intrathyroidal parathyroid adenoma. Serum calcium and PTH levels declined after this operation. A nodular lesion was found in the cut sections of the resected specimen, which was consistent with the result of the scintiscanning. Histological examinations revealed a papillary adenocarcinoma of the thyroid gland, and the PTH-immunoreactivity in the tumor cells was confirmed. These findings strongly suggest that PTH could be produced ectopically by the papillary adenocarcinoma of the thyroid gland.

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