小细胞肺癌合并高血钙及急性肾衰竭.docVIP

Small cell lung cancer with hypercalcemia and acute renal failure: an uncommon complication and literature review Yen-Hung Yao1, Sung-Hua Chuang1, Wu-Chang Yang1, Ng Yee-Yung 1 1Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital Running title: Small cell lung cancer and hypercalcemia Correspondence should be addressed to: Yee-Yung Ng, MD. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan Tel: 886-2-2871-2121 ext 2993; Fax: 886-2E-mail:yyng@vghtpe.gov.tw Adress for reprint requests: Taipei Veterans General Hospital No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan 小細胞肺癌合併高血鈣及急性腎衰竭 高血鈣常見於乳癌、鳞狀細胞肺癌、及多發性骨髓瘤等病患，但少見於小細胞肺癌。各種細胞型態的肺癌，包括小細胞肺癌，均有相當高比例會分泌副甲狀腺荷爾蒙相關蛋白Parathyroid hormone-related protein, PTHrP）。不同細胞型態的肺癌合併高血鈣的發生率各異，這可能與PTHrP的分泌型態或速度不同有關。文獻報告小細胞肺癌引發高血鈣的機會與腫瘤大小有關。此外，我們回顧有關小細胞肺癌合併高血鈣（12mg/dL）的個案報告，發現病患均有骨轉移。本文報導一位小細胞肺癌病患，腫瘤迅速擴大且合併骨轉移，於住院中發生高血鈣與急性腎衰竭，最後過世。雖然小細胞肺癌患者甚少發生高血鈣，若腫瘤體積較大或合併骨轉移時，臨床醫師仍需追蹤血鈣濃度，以及早診斷高血鈣並預防其併發症。 關鍵字：小細胞肺癌，高血鈣，骨轉移 Abstract Hypercalcemia is relatively common in patients with malignancies, especially breast cancer, squamous cell lung cancer and multiple myeloma, but uncommon in patients with small cell lung cancer. Actually all types of lung cancer have high incidence of abnormal parathyroid hormone-related protein (PTHrP) secretion, including small cell lung cancer. The different incidence of hypercalcemia between squamous cell and small cell lung cancers may result from different patterns or rates of PTHrP secretion. Besides, patients of small cell lung cancer with serum calcium level greater than 12mg/dL usually had concurrent bone metastasis or larger tumor burden. We report a patient of small cell lung cancer with large tumor burden and extensive bone metastases. The patient suffered from hypercalcemia with acute renal failure and was expired soon after the diagnosis was made. In summary, although hypercalcemia is unc