Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1975 Feb;181(2):226–231. doi: 10.1097/00000658-197502000-00018

The differentiation of primary hyperparathyroidism from the hypercalcemia of malignancy.

N B Ackerman, N Winer
PMCID: PMC1343758  PMID: 1111456

Abstract

The presence of hypercalcemia in patients with known cancers may be due to the cancers themselves, or to co-existing primary hyperparathyroidism. The differentiation of primary hyperparathyroidism from the hypercalcemia of malignancy is important since the relief of distressing symptoms and prevention of hypercalcemic crises and renal failure can be accomplished relatively easily by parathyroid surgery in the former condition, and only with difficulty, at times, with fluids and drugs in the latter condition. The histories of three recent patients are presented, which demonstrate the difficulties inherent in the differentiation of these conditions. These patients were ultimately found at operation to have primary hyperparathyroidism in addition to malignancies of the cervix, adrenal gland and kidney. In our experience the following have been helpful in establishing a diagnosis; history of hypercalcemia prior to development of cancer, the type of cancer itself, the effect of cancer therapy on the hypercalcemia, and selective venous sampling with radioimmunoassay for parathyroid hormone.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ackerman N. B., Winer N. Evaluation of methods for localizing parathyroid tumors. Am J Surg. 1971 Nov;122(5):669–673. doi: 10.1016/0002-9610(71)90297-2. [DOI] [PubMed] [Google Scholar]
  2. Ariyan S., Farber L. R., Hamilton B. P., Papac R. J. Pseudohyperparathyroidism in head and neck tumors. Cancer. 1974 Jan;33(1):159–166. doi: 10.1002/1097-0142(197401)33:1<159::aid-cncr2820330124>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  3. Arnaud C. D. Editorial: Parathyroid hormone: coming of age in clinical medicine. Am J Med. 1973 Nov;55(5):577–581. doi: 10.1016/0002-9343(73)90178-2. [DOI] [PubMed] [Google Scholar]
  4. Arnaud C. D. Immunochemical heterogeneity of circulating parathyroid hormone in man: sequel to an original observation by Berson and Yalow. Mt Sinai J Med. 1973 May-Jun;40(3):422–432. [PubMed] [Google Scholar]
  5. Bender R. A., Hansen H. Hypercalcemia in bronchogenic carcinoma. A prospective study of 200 patients. Ann Intern Med. 1974 Feb;80(2):205–208. doi: 10.7326/0003-4819-80-2-205. [DOI] [PubMed] [Google Scholar]
  6. Davis H. L., Jr, Wiseley A. N., Ramirez G., Ansfield F. J. Hypercalcemia complicating breast cancer. Clinical features and management. Oncology. 1973;28(2):126–137. doi: 10.1159/000224810. [DOI] [PubMed] [Google Scholar]
  7. Doppman J. L., Wells S. A., Shimkin P. M., Pearson K. D., Bilezikian J. P., Heath D. A., Powell D., Ketcham A. S., Aurbach G. D. Parathyroid localization by angiographic techniques in patients with previous neck surgery. Br J Radiol. 1973 Jun;46(546):403–418. doi: 10.1259/0007-1285-46-546-403. [DOI] [PubMed] [Google Scholar]
  8. Farr H. W., Fahey T. J., Jr, Nash A. G., Farr C. M. Primary hyperparathyroidism and cancer. Am J Surg. 1973 Oct;126(4):539–543. doi: 10.1016/s0002-9610(73)80046-7. [DOI] [PubMed] [Google Scholar]
  9. GOLDBERG M. F., TASHJIAN A. H., Jr, ORDER S. E., DAMMIN G. J. RENAL ADENOCARCINOMA CONTAINING A PARATHYROID HORMONE-LIKE SUBSTANCE AND ASSOCIATED WITH MARKED HYPERCALCEMIA. Am J Med. 1964 May;36:805–814. doi: 10.1016/0002-9343(64)90188-3. [DOI] [PubMed] [Google Scholar]
  10. HODGKINSON A. HYPERPARATHYROIDISM AND CANCER. Br Med J. 1964 Aug 15;2(5406):444–444. doi: 10.1136/bmj.2.5406.444-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jorgensen H. Hypercalcemia in adrenocortical insufficiency. Acta Med Scand. 1973 Mar;193(3):175–179. [PubMed] [Google Scholar]
  12. Katz A., Kaplan L., Massry S. G., Heller R., Plotkin D., Knight I. Primary hyperparathyroidism in patients with breast carcinoma. Arch Surg. 1970 Nov;101(5):582–585. doi: 10.1001/archsurg.1970.01340290038008. [DOI] [PubMed] [Google Scholar]
  13. Lafferty F. W. Pseudohyperparathyroidism. Medicine (Baltimore) 1966 May;45(3):247–260. doi: 10.1097/00005792-196605000-00004. [DOI] [PubMed] [Google Scholar]
  14. Muggia F. M., Heinemann H. O. Hypercalcemia associated with neoplastic disease. Ann Intern Med. 1970 Aug;73(2):281–290. doi: 10.7326/0003-4819-73-2-281. [DOI] [PubMed] [Google Scholar]
  15. Omenn G. S., Roth S. I., Baker W. H. Hyperparathyroidism associated with malignant tumors of nonparathyroid origin. Cancer. 1969 Nov;24(5):1004–1011. doi: 10.1002/1097-0142(196911)24:5<1004::aid-cncr2820240520>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  16. Paloyan E., Farland M., Pickleman J. R. Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration. JAMA. 1969 Nov 17;210(7):1243–1245. [PubMed] [Google Scholar]
  17. Powell D., Murray T. M., Pollard J. J., Cope O., Wang C. A., Potts J. T., Jr Parathyroid localization using venous catheterization and radioimmunoassay. Arch Intern Med. 1973 May;131(5):645–648. [PubMed] [Google Scholar]
  18. Powell D., Singer F. R., Murray T. M., Minkin C., Potts J. T., Jr Nonparathyroid humoral hypercalcemia in patients with neoplastic diseases. N Engl J Med. 1973 Jul 26;289(4):176–181. doi: 10.1056/NEJM197307262890403. [DOI] [PubMed] [Google Scholar]
  19. Riggs B. L., Arnaud C. D., Reynolds J. C., Smith L. H. Immunologic differentiation of primary hyperparathyroidism from hyperparathyroidism due to nonparathyroid cancer. J Clin Invest. 1971 Oct;50(10):2079–2083. doi: 10.1172/JCI106701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Roof B. S., Carpenter B., Fink D. J., Gordan G. S. Some thoughts on the nature of ectopic parathyroid hormones. Am J Med. 1971 May;50(5):686–691. doi: 10.1016/0002-9343(71)90124-0. [DOI] [PubMed] [Google Scholar]
  21. Sherwood L. M., O'Riordan J. L., Aurbach G. D., Potts J. T., Jr Production of parathyroid hormone by nonparthyroid tumors. J Clin Endocrinol Metab. 1967 Jan;27(1):140–146. doi: 10.1210/jcem-27-1-140. [DOI] [PubMed] [Google Scholar]
  22. Terz J. J., Estep H., Bright R., Lawrence W., Jr, Curutchet H. P., Kay S. Proceedings: Primary oropharyngeal cancer and hypercalcemia. Cancer. 1974 Feb;33(2):334–339. doi: 10.1002/1097-0142(197402)33:2<334::aid-cncr2820330206>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  23. Warren M. M., Utz D. C., Kelalis P. P. Concurrence of hypernephroma and hypercalcemia. Ann Surg. 1971 Nov;174(5):863–865. doi: 10.1097/00000658-197111000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES