Medline ® Abstract for Reference 48
Survival in hypercalcaemic patients with cancer and co-existing primary hyperparathyroidism.
Hutchesson AC, Bundred NJ, Ratcliffe WA
Postgrad Med J. 1995;71(831):28.
Hypercalcaemia associated with malignancy is generally thought to carry a poor prognosis. Of 47 consecutive patients with hypercalcaemia and malignancy, serum parathyroid hormone (PTH) was elevated in seven, consistent with co-existing hyperparathyroidism. Median survival from onset of hypercalcaemia in these seven patients was 817 days; compared to 33 days in the remaining 40 patients with hypercalcaemia of malignancy, in whom PTH was suppressed (p = 0.007). Among patients with hypercalcaemia of malignancy, plasma PTH-related protein (PTHrP) concentration showed no correlation with survival (r2 = 2.1%), but one patient with increased levels of both PTH and PTHrP survived only nine days after the onset of hypercalcaemia. A raised PTH had a positive predictive value of 86% for survival>100 days, and of 71% for survival>1 year. A raised plasma PTHrP predicted death within 100 days with a positive predictive value of 69%. We conclude that measurement of serum PTH is indicated in patients with hypercalcaemia and malignancy to identify the 15% with hyperparathyroidism, since this is associated with prolonged survival. In patients with hyperparathyroidism, assay of plasma PTHrP may indicate concurrent hypercalcaemia of malignancy, with an associated poor prognosis.
Selly Oak Hospital, Birmingham, UK.