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Hypercalcämie bei malignen Erkrankungen

Hypercalcemia in malignancy

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Summary

Hypercalcemia accompanies often malignant diseases. The majority of cases of malignancy complicated by hypercalcemia is induced by metastases involving bone, hypercalcemia may also accompany localised tumors. Various hormones have been implicated in the genesis of malignant hypercalcemia: ectopic secretion of parathyroid hormone by tumor or orthotopic secretion by concomitant primary hyperparathyroidism, prostaglandin activating osteoclasts, production of hypercalcemic factor other than these hormones. This review summarizes current knowledge about endocrine-mediated mechanisms which produce hypercalcemia and about its frequency and mechanism in different types of tumors.

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Literatur

  1. Ackerman NB, Winer N (1975) The differentiation of primary hyperparathyroidism from the hypercalcemia of malignancy. Ann Surg 181:226–229

    PubMed  Google Scholar 

  2. Albright F (1941) Case records of the Massachusetts General Hospital. Case 39061. N. Engl J Med 225:789–796

    Google Scholar 

  3. Atkins D, Ibbotson KJ, Hillier K (1977) Secretion of prostaglandins as bone resorbing agents by renal cortical carcinoma in culture. Br J Cancer 36:601–607

    PubMed  Google Scholar 

  4. Bartholomew LG, Schütt AJ (1971) Systemic syndromes associated with neoplastic disease including cancer of the colon. Cancer 28:170–174

    PubMed  Google Scholar 

  5. Barz D (1974) Sektionsstatistische Untersuchungen der Metastasierung der malignen Geschwülste des weiblichen Genitale. Med Dipl Arbeit, Dresden

  6. Bender RA, Hansen H (1974) Hypercalcemia in bronchogenic carcinoma. A prospective study of 200 patients. Ann Intern Med 80:205–208

    PubMed  Google Scholar 

  7. Benrey J, Graham DY, Goyal RK (1974) Hypercalcemia and carcinoma of the esophagus. Ann Intern Med 80:415–416

    PubMed  Google Scholar 

  8. Bloch KJ, Lee L, Mills JA, Haber E (1973) Gamma heavy chain disease — An expanding clinical and laboratory spectrum. Am J Med 55:61–70

    PubMed  Google Scholar 

  9. Boasberg P (1973) Estrogen-induced hypercalcemia. JAMA 224:1190

    Google Scholar 

  10. Boey JH, Gilbert JM, Cooke TJC, Sweeney EC, Taylor S (1975) Occurence of other endocrine tumors in primary hyperparathyroidism. Lancet II:781–784

    Google Scholar 

  11. Borden H, Hummer GJ, Landon CW, Paris J (1976) The use of procaine in acquired malignant hyperthermia in a patient with malignant melanoma metastatic to parathyroid gland. Can Anesth Soc J 23:616–623

    Google Scholar 

  12. Bounameaux HM, Schifferli J, Montani JP, Jung A, Chatelanat F (1983) Renal failure associated with intravenous diphosphonates. Lancet 1:471

    Google Scholar 

  13. Brereton HD, Halushka PV, Alexander RW, Mason DM, Keiser HR, De Vita VT jr (1974) Indomethacin-responsive hypercalcemia in a patient with renal-cell adenocarcinoma. N Engl J Med 291:83–85

    PubMed  Google Scholar 

  14. Breukelen FJM Van, Bijvoet OLM, Oosterom AT Van (1979) Inhibition of osteolytic bone lesions by (3-amino-1-hydroxypropylidene)-1,1-biphosphonate (A.P.D.). Lancet 1:803–805

    PubMed  Google Scholar 

  15. Carey RW, Schmitt GW, Kopald HH (1968) Masive extraskeletal calcification during phosphate treatment of hypercalcemia. Arch Intern Med 122:150–155

    PubMed  Google Scholar 

  16. Chase LR, Aurbach GD (1970) The effect of parathyroid hormone on the concentration of adenosine 3′,5′-monophosphate in skeletal tissue, in vitro. J Biol Chem 245:1520–1526

    PubMed  Google Scholar 

  17. Chapuy MC, Meunier PJ, Alexandre CM (1980) Effects of disodium dichloromethylene diphosphatase on the hypercalcemia product by bone metastases. J Clin Invest 65:1243–1247

    PubMed  Google Scholar 

  18. Chisholm GD, Roy RR (1971) The systemic effects of malignant renal tumors. Br Journ Urol 43:687–700

    Google Scholar 

  19. Colls BM, Lorier MA (1975) Immunocytoma, cancer and other associations of monoclonal gammopathy. NZ Med J 82:221–226

    Google Scholar 

  20. Coombes RC, Ward MK, Greenberg PB, Hillyard CJ, Tulloch BR, Morrison R, Joplin GF (1976) Calcium metabolism in cancer. Cancer 38:2111–2120

    PubMed  Google Scholar 

  21. Cooperative Study by Acute Leukemia Group B (1975) Correlation of abnormal immunoglobulin with clinical features of myeloma. Arch Intern Med 135:46–52

    Google Scholar 

  22. Davis HL, Wiseley AN, Ramirez G, Ansfield FJ (1973) Hypercalcemia complicating breast cancer. Oncology 28:126–137

    PubMed  Google Scholar 

  23. Demers LM, Allegra JC, Harvey HA, Lipton A, Luderer JR, Mortel R, Brenner DE (1977) Plasma prostaglandins in hypercalcemic patients with neoplastic disease. Cancer 39:1559–1562

    PubMed  Google Scholar 

  24. Dexter RN, Mullinar F, Estep HL, Williams RC (1972) Monoclonal IgG gammopathy and hyperparathyroidism. Ann Intern Med 77:759–764

    PubMed  Google Scholar 

  25. Eisman JA, Martin TJ, MacIntyre I (1979) 1,25-dihydroxy-vitamin D, receptor in breast cancer cells. Lancet II:1335–1336

    Google Scholar 

  26. Ellis HA, Floyd M, Herbert FK (1971) Recurrent hyperparathyroidism due to parathyroid carcinoma. J Clin Pathol 24:596–604

    PubMed  Google Scholar 

  27. Farr HW, Famey TJ, Nash AG, Farr CM (1973) Primary hyperparathyroidism and cancer. Am J Surg 126:539–543

    PubMed  Google Scholar 

  28. Ferenczy A, Okagaki T, Richart RM (1971) Para-endocrine hypercalcemia in ovarian neoplasms. Cancer 27:427–433

    PubMed  Google Scholar 

  29. Finlayson JF, Casey JH (1975) Hypercalcemia and multiple pheochromocytomas. Ann Intern Med 82:810–811

    Google Scholar 

  30. Fleisch H, Russell RGG, Francis MD (1969) Diphosphonates inhibit hydroxyapatite dissolution in vitro and bone resorption in tissue culture and in vivo. Science 165:1262–1264

    PubMed  Google Scholar 

  31. Fry L (1961) Pseudohyperparathyroidism with carcinoma of bronchus. Br Med J I:301–302

    Google Scholar 

  32. Galasko CSB, Bennett A (1976) Relationship of bone destruction in skeletal metastases to osteoclast activation and prostaglandins. Nature 263:508–510

    PubMed  Google Scholar 

  33. Galasko CSB (1981) Bone metastases studied by experimental models. Schweiz Med Wochenschr 111:1862–1868

    PubMed  Google Scholar 

  34. Gardner JD (1975) Pancreatic cholera. West J Med 123:309–310

    PubMed  Google Scholar 

  35. Gasser AB, Burkhardt P (1978) Le dosage de la parathormone plasmatique dans le diagnostic différentiel des hypercalcémies accompagnant les tumeurs malignes. Schweiz Med Wochenschr 108:1031–1034

    PubMed  Google Scholar 

  36. Golitz LE, Field JP (1972) Metastatic calcification with skin necrosis. Arch Dermat 106:398–402

    Google Scholar 

  37. Gordan GS, Eisenberg E, Loken HF, Gardner B, Hayashida T (1962) Clinical endocrinology of parathyroid hormone excess. Recent Progr Horm Res 18:297–336

    Google Scholar 

  38. Gordan GS, Cantino TJ, Erhardt L, Hansen J, Lubich W (1966) Osteolytic sterol in human breast cancer. Science 151:1226–1228

    PubMed  Google Scholar 

  39. Greaves M, Ibbotson KJ, Atkins D (1980) Prostaglandins as mediators of bone resorption in renal and breast tumors. Clin Sci 58:201–210

    PubMed  Google Scholar 

  40. Hall SW, Luna MA, Bedrossian C, Rodriguez V (1978) Calcinosis in nonparathyroid malignant disease: An unusual case report and clinicopathologic review of 17 cases. Med Pediat Oncol 4:49–58

    Google Scholar 

  41. Heath DA (1976) Hypercalcemia and malignancy. Ann Clin Biochem 13:555–560

    PubMed  Google Scholar 

  42. Heath H, Edis AJ (1979) Pheochromocytoma associated with hypercalcemia and ectopic secretion of calcitonin. Ann Intern Med 91:208–210

    PubMed  Google Scholar 

  43. Hirose S, Kobayashi K, Kajikawa K, Sawabu N, Takeuchi J (1975) A case of water diarrhea, hypokalemia, and hypercalcemia associated with non-ulcerogenic islet cell turnover of the pancreas. Am Gastroenterol 64:382–391

    Google Scholar 

  44. Hirsch PF, Munson PL (1969) Thyrocalcitonin. Physiol Rev 49:548–622

    PubMed  Google Scholar 

  45. Horton JE, Raisz LG, Simmons HA, Oppenheim JJ, Mergenhagen SE (1972) Bone resorbing activity in supernatant fluid from cultured human peripheral blood leukocytes. Science 177:793–795

    PubMed  Google Scholar 

  46. Jacobs TP, Siris ES, Bilezikian JP, Baquiran DC, Shane E, Canfield RE (1981) Hypercalcemia of malignancy: treatment with intravenous dichloromethylene diphosphonate. Ann Inter Med 94:312–316

    Google Scholar 

  47. Johansson H, Werner I (1975) Dysproteinemia, malignancy, and hyperparathyroidism. Ann Intern Med 83:121–122

    Google Scholar 

  48. Jordan GW (1966) Serum calcium and phosphorus abnormalities in leukemia. Am J Med 41:381–385

    PubMed  Google Scholar 

  49. Josse RG, Murray TM, Mundy GR (1981) Observations on the mechanism of bone resorption induced by multiple myeloma marrow culture fluids and partially purified osteoclast activating factor. J Clin Invest 67:1472–1481

    PubMed  Google Scholar 

  50. Lafferty FW (1966) Pseudohyperparathyroidism. Medicine 45:247–260

    PubMed  Google Scholar 

  51. Laryea EA, Brodrick R, Hidvegi R (1974) Hypercalcemia and streptozotocin. Ann Intern Med 80:276–277

    Google Scholar 

  52. Lazor MZ, Rosenberg LE (1964) Mechanisms of adrenalsteroid reversable hypercalcemia in multiple myeloma. N Engl J Med 270:749–755

    PubMed  Google Scholar 

  53. Lokich JJ, Harrison JH (1975) Renal cell carcinoma: Natural history and chemotherapy experience. J Urol 114:371–376

    PubMed  Google Scholar 

  54. Luben RA, Mundy GR, Trummel CL, Raisz LG (1974) Partial purification of osteoclast-activating factor from phytohemagglutinin-stimulated human leukocytes. J Clin Invest 53:1473–1480

    PubMed  Google Scholar 

  55. Luben RA (1980) An assay for osteoclast-activating factor (OAF) in biological fluids: Detection of OAF in the serum of myeloma patients. Cell Immunol 49:74

    PubMed  Google Scholar 

  56. Malakoff AF, Schmidt JD (1975) Metastatic carcinoma of penis complicated by hypercalcemia. Urology 5:510–513

    PubMed  Google Scholar 

  57. Mandell J, Magee MC, Fried FA (1977) Hypercalcemia associated with uroepithelial neoplasms. J Urol 119:844–845

    Google Scholar 

  58. Mann NS, Sachdev AJ (1977) Carcinoma of the esophagus and hypercalcemia. Am J Gastroenterol 67:135–140

    PubMed  Google Scholar 

  59. Margolius S, Homcy C (1972) Systemic manifestations of hepatoma. Medicine 51:381–391

    PubMed  Google Scholar 

  60. Martin TJ, Atkins D (1979) Biochemical regulators of bone resorption and their significance in cancer. Essays in Med Biochem 4:49–82

    Google Scholar 

  61. Marx SJ, Spiegel AM, Brown EM (1978) Divalent cation metabolism: Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism. Am J Med 65:235–242

    PubMed  Google Scholar 

  62. Mckay HA, Gavrell GJ, Meehan WL, Kapla RA, Leblanc GA (1978) Prostaglandin-mediated hypercalcemia in transitional cell carcinoma of the bladder. J Urol 119:689–692

    PubMed  Google Scholar 

  63. Mckee LC Jr (1974) Hypercalcemia in leukemia. South Med J 67:1076–1079

    PubMed  Google Scholar 

  64. Melvin KEW, Tashjian AH Jr, Miller HH (1972) Studies in familial (medullary) thyroid carcinoma. Recent Progr Hormone Res 28:399–470

    PubMed  Google Scholar 

  65. Menguy R (1969) Pseudohyperparathyroidism due to malignant melanoma. Surg Clin North Am 49:49–56

    PubMed  Google Scholar 

  66. Metcalfe JB, Carey JC, Barry JM (1978) Genitourinary malignancy and pseudohyperparathyroidism. J Urol 119:702–704

    PubMed  Google Scholar 

  67. Minkin C, Fredricks RS, Pokress S (1982) Bone resorption and humoral hypercalcemia of malignancy: Stimulation of bone resorption in vitro by tumor extracts is inhibited by prostaglandin synthesis inhibitors. J Clin Endocrinol Metab 53:941–947

    Google Scholar 

  68. Mödder B, Schulze E, Dickmanns HA, Heresen D (1981) Das Hyperkalzämie-Syndrom bei akuter Leukose. Inn Med 8:20–26

    Google Scholar 

  69. Muggia FM, Heinemann HO (1970) Hypercalcemia associated with neoplastic disease. Ann Intern Med 73:281–290

    PubMed  Google Scholar 

  70. Mundy GR, Luben RA, Raisz LG, Oppenheim JJ, Buell DN (1974) Bone-resorbing activity in supernatants from lymphoid cell lines. N Engl J Med 290:867–871

    PubMed  Google Scholar 

  71. Mundy GR, Raisz LG, Cooper RA, Schechter G, Salmon SE (1974) Evidence for the secretion of an osteoclast stimulating factor in myeloma. N Engl J Med 291:1041–1046

    PubMed  Google Scholar 

  72. Mundy GR, Rick ME, Turcotte R, Kowalsky MA (1978) Pathogenesis of hypercalcemia in lymphosarcoma cell leukemia. Role of an osteoclast activating factor-like substance and mechanism of action for glucocorticoid therapy. Am J Med 65:600–606

    PubMed  Google Scholar 

  73. Murie N, Ferrand B, Etienne P (1973) Le cancer des parathyroides. Nouv Presse Med 2:1293–1296

    PubMed  Google Scholar 

  74. Murray TM, Josse RG, Heersche JNM (1978) Hypercalcemia and cancer: an update. CMA J 119:915–920

    Google Scholar 

  75. Myers WPL (1960) Hypercalcemia in neoplastic disease. Arch Surg 80:308–318

    PubMed  Google Scholar 

  76. Myers WPL (1962) Studies of serum calcium regulation. Adv Intern Med 11:163–213

    PubMed  Google Scholar 

  77. Myers WPL, Rothschild EO, Carney V (1968) Tumorassociated hypercalcaemia-radiocalcium and bone culture studies (Abstr). Calcif Tiss Res 2:63–67

    Google Scholar 

  78. Nathanson L, Hall TC (1974) Lung tumors: How they produce their syndromes. Ann NY Acad Sci 230:367–377

    PubMed  Google Scholar 

  79. Nordin BEC, Pcacock M (1969) Role of kidney in regulation of plasma calcium. Lancet 2:1280–1282

    PubMed  Google Scholar 

  80. Olsson AM, Jönsson G (1977) Advanced cancer of the prostate combined with hypercalcaemia. Scand J Urol Nephrol 11:293–296

    PubMed  Google Scholar 

  81. Omenn GS, Roth SI, Baker WH (1969) Hyperparathyroidism associated with malignant tumors of nonparathyroid origin. Cancer 24:1004–1012

    PubMed  Google Scholar 

  82. O'Regan S, Carson S, Chesney RW, Rummond KN (1977) Electrolyte and acid-base disturbances in the management of leukemia. Blood 49:345

    PubMed  Google Scholar 

  83. Powell D, Singer FR, Murray TM, Minkin C, Potts JT Jr (1973) Nonparathyroid humoral hypercalcemia in patients with neoplastic diseases. N Engl J Med 289:176–181

    PubMed  Google Scholar 

  84. Raisz LG, Brand JS, Au WYW (1968) Interactions of parathyroid hormone and thyrocalcitonin on bone resorption in tissue culture. In: Talmage RV, Belanger LF (eds): Parathyroid hormone and calcitonin. International Congress Series, Vol 159. Excerpta Medica, Amsterdam, pp 370–380

    Google Scholar 

  85. Raisz LG, Niemann I (1969) Effect of phosphate, calcium and magnesium on bone resorption and hormonal responses in tissue culture. Endocrinol 85:446–452

    Google Scholar 

  86. Raisz LG, Luben RA, Mundy GR (1975) Effects of osteoclast activating factor from human leukocytes on bone metabolism. J Clin Invest 56:408–413

    PubMed  Google Scholar 

  87. Raisz LG, Mundy GR, Eilon G (1978) Hypercalcemia of neoplastic disease. In: Copp DH, Talmage RV (eds): Endocrinology of calcium metabolism. Excerpta Medica, Amsterdam, pp 64–70

    Google Scholar 

  88. Raisz LG, Yajnik CH, Bockmann RS (1979) Comparison of commercially available parathyroid hormone immunoassays in the differential diagnosis of hypercalcemia due to primary hyperparathyroidism of malignancy. Ann Intern Med 91:739–740

    PubMed  Google Scholar 

  89. Robertson RP, Baylink DJ, Metz SA, Cummings KB (1976) Plasma prostaglandin E in patients with cancer with and without hypercalcemia. J Clin Endocrinol Metab 43:1330–1335

    PubMed  Google Scholar 

  90. Rothschild E Studies of the hypocalcemic effect of mithramycin. 49th Endocrinol Soc Meeting, June 1967 (Abstr)

  91. Rude RK, Sharp CF Jr, Fredericks RS (1981) Urinary and the nephrogenous adenosine 3′,5′-monophosphate in the hypercalcemia of malignancy. J Clin Endocrinol Metab 52:765–771

    PubMed  Google Scholar 

  92. Samaan NA, Hickey RC, Sethi MR, Yang KP, Wallace S (1976) Hypercalcemia in patients with known malignant disease. Surgery 80:382–389

    PubMed  Google Scholar 

  93. Schajowicz F (1981) Tumors and tumorlike lesions of bone and joints. Springer, Berlin Heidelberg New York

    Google Scholar 

  94. Schwazr G, Hoffmeister W, Loewe KI (1966) Ein bisher unbekannter Mechanismus der Entstehung von Hypercalciämien bei der Leukämie. Dtsch Med Wochenschr 91:2153–2156

    PubMed  Google Scholar 

  95. Seyberth HW, Segre GV, Morgan JL, Sweetman BJ, Potts JT, Oates JA (1975) Prostaglandins as mediators of hypercalcemia associated with certain types of cancer. N Engl J Med 293:1278–1283

    PubMed  Google Scholar 

  96. Seyberth HW, Segre GV, Hamet P, Sweetman BJ, Potts JT Jr, Oates JA (1976) Characterization of the group of patients with hypercalcemia of cancer who respond to treatment with prostaglandin synthesis inhibitors. Trans Ann Am Phys 89:92–104

    Google Scholar 

  97. Sharp CF Jr, Rude RK, Singer FR (1981) Parathyroid hormone in human carcinomas: A doubtful cause of hypercalcemia. Clin Res 29:545 A

    Google Scholar 

  98. Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF (1971) Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 28:1165–117

    PubMed  Google Scholar 

  99. Spiegel A, Greene M, Magrath I, Balow J, Marx S, Aurbach GD (1978) Hypercalcemia with suppressed parathyroid hormone in Burkitt's Lymphoma. Am J Med 64:691–695

    PubMed  Google Scholar 

  100. Stephens RL, Hansen HH, Muggia FM (1973) Hypercalcemia in epidermoid tumors of the head and neck and esophagus. Cancer 31:1487–1491

    PubMed  Google Scholar 

  101. Stewart AF, Horst R, Deftos LJ (1980) Biochemical evaluation of patients with cancer-associated hypercalcemia. Evidence for humoral and non-humoral groups. N Engl J Med 303:1377–1383

    PubMed  Google Scholar 

  102. Strumpf M, Kowalski MA, Mundy GR (1978) Effect of glucocorticoids on osteoclast activating factor. J Lab Clin Med 92:772–778

    PubMed  Google Scholar 

  103. Szymendera J (1970) Bone mineral metabolism in cancer. Recent Results Cancer Res 27:84–88

    Google Scholar 

  104. Tashijan AH (1969) Animal cell cultures as a source of hormones. Biotech Bioeng 11:109–126

    Google Scholar 

  105. Tashijan AH Jr, Wright DR, Ivey JL (1978) Calcitonin binding sites in bone. Relationships to biological response and escape. Recent Prog Horm Res 34:285–334

    PubMed  Google Scholar 

  106. Terz JJ, Estep H, Bright R, Lawrence W, Curutchet P, Kay S (1974) Primary oropharyngeal cancer and hypercalcemia. Cancer 33:334–339

    PubMed  Google Scholar 

  107. Underwood JCE (1974) Lymphoreticular infiltration in human tumors: Prognostic and biological implications: A review. Br J Cancer 30:538–548

    PubMed  Google Scholar 

  108. Walker IR (1974) Lymphoma with hypercalcemia. CMA 111:928–930

    Google Scholar 

  109. Walser M (1961) Calcium clearance is a function of saline clearance in the dog. Am J Physiol 200:1099–1104

    PubMed  Google Scholar 

  110. Walther HE (1948) Krebsmetastasen. Verlag Benno Schwabe, Basel

    Google Scholar 

  111. Warren W, Shields MH (1966) In: Anderson WAD (ed) Textbook of pathology, Mosby, 5th edn, St Louis, p 408

  112. Warwick OH, Yendt ER, Olin JS (1961) The clinical features of hypercalcaemia associated with malignant disease. CMA J 85:719–724

    Google Scholar 

  113. Willis RA (1973) The spread of tumors in the human body. 3rd edn. Butterworths, London

    Google Scholar 

  114. Yarbro JW, Kennedy BJ, Barnum CP (1966) Mithramycin inhibition of ribonucleic acid synthesis. Cancer Res 26:36–40

    PubMed  Google Scholar 

  115. Yoneda T, Mundy GR (1979) Prostaglandins are necessary for osteoclast activating factor (OAF) production by activated peripheral blood leukocytes. J Exp Med 149:279–283

    PubMed  Google Scholar 

  116. Yoneda T, Mundy GR (1979) Monocytes regulate osteoclast activating factor production by releasing prostaglandins. J Exp Med 150:338–350

    PubMed  Google Scholar 

  117. Yu JH, Wells H, Ryan WJ Jr, Lloyd WS (1976) Effects of prostaglandins and other drugs on the cyclic AMP content of cultured bone cells. Prostaglandins 12:501–513

    PubMed  Google Scholar 

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  1. Med. Univ.-Klinik, Nephrologische Abteilung, Würzburg

    E. Heidbreder, K. Schafferhans & A. Heidland

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Heidbreder, E., Schafferhans, K. & Heidland, A. Hypercalcämie bei malignen Erkrankungen. Klin Wochenschr 61, 773–783 (1983). https://doi.org/10.1007/BF01496721

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