Tumor-Associated Hypercalcemia in a Patient with Paget's Disease

Paget氏病合併腫瘤相關之高血鈣症

洪皓彰(Hao-Chang Hung) ； 歐弘毅(Horng-Yih Ou) ； 黃振勳(Jehn-Shyun Huang) ； 莊明哲(Ming-Che Chuang) ； 吳達仁(Ta-Jen Wu)

《The Kaohsiung Journal of Medical Sciences》 24卷3期 (2008/03) Pp. 152-156

摘要

Paget氏病的特色是骨頭局部不正常的快速吸收並增生，通常沒有症狀或是只發現異常高的鹼性磷酸酶。它在西方國家並不少見，但在亞洲及非洲則相當罕見。我們報告一位七十六歲女性的Paget氏病人以臉部蜂窩性組識炎表現，在九年長期追蹤後發生無症狀的高血鈣症，副甲狀腺素濃度並不高，鹼性磷酸酶濃度顯示疾病活性也不高，其他並無明顯造成高血鈣的原因。使用雙磷酸鹽治療後，鹼性磷酸酶濃度恢復正常，但無症狀之高血鈣症持續。經腫瘤指標及影像學檢查，臨床診斷發現胰臟腫瘤併多發性肝臟與肺臟轉移。Paget氏病合併高血鈣症應考慮惡性腫瘤的可能性。

關鍵字

高血鈣症 ； Paget氏病

並列摘要

Paget's disease of the bone, which is characterized by a focal region of highly exaggerated bone remodeling, is very rare in Asia. Most patients with Paget's disease are asymptomatic; they are normocalcemic and show elevated alkaline phosphatase levels. Hypercalcemia in patients with Paget's disease has rarely been reported. We report one Chinese patient with Paget's disease involving the maxilla bone with an initial presentation of facial cellulitis. Asymptomatic hypercalcemia with a low-normal intact parathyroid hormone level developed 9 years later. After clodronate treatment, the level of alkaline phosphatase normalized, but the hypercalcemia did not respond adequately. After analysis of tumor markers and imaging studies, a clinical diagnosis of pancreatic adenocarcinoma with multiple hepatic and lung metastases with pleural effusion was made. We suggest that malignancy-associated hypercalcemia should be considered as one of the causes of hypercalcemia in patients with Paget's disease.

並列關鍵字

hypercalcemia ； Paget's disease