Tumor hypercalcemia

One to malignancy (tumor-induced hypercalcemia (TIH), Tumorhypercalcämie) is an elevated concentration of calcium in blood serum in indirect consequence malignant (malignant) tumor growth ( " paraneoplastic phenomenon"). The mechanisms underlying this hypercalcaemia are diverse. About 10% of all patients with malignancies develop hypercalcemia.

causes

The most common cause of tumor hypercalcaemia is the paraneoplastic formation of parathyroid hormone-related protein (PTHrP). Lung cancer , esophageal cancer , malignant melanoma of the skin and pancreatic cancer, and hemoblastosis are some examples of tumors that frequently form PTHrP. PTHrP has a similar structure as the physiologically in the parathyroid formed parathyroid hormone and can over the parathyroid hormone receptor have the same effect. Among other things, parathyroid hormone and PTHrP promote bone resorption, so that calcium is released into the blood, and increase calcium re-absorption (reabsorption) in the kidneys. Very rarely, tumor cells are also able to form paraneoplastic parathyroid hormone. This is known z. B. in tumors of the kidneys, lungs, ovaries, thyroid and thymus.

Some tumors, such as hemoblastoses and lymphomas, form paraneoplastic cytokines that can induce osteoclasts to break down bone (osteolysis). This also leads to a release of calcium into the blood. A common, relatively well-studied disease, plasmacytoma , for example, forms the cytokine RANK ligand (RANKL), which can inhibit the formation of osteoprotegerin .

The osteolytic hypercalcemia is the second most common cause to malignancy.

There are also numerous rarer causes.

literature

• Siegenthaler (Ed.): Clinical Pathophysiology. 9th edition, Georg Thieme Verlag Stuttgart, 2006, page 306 ff. ISBN 3-13-449609-7 . In Google Books .

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