악성종양에 동반된 고칼슘혈증에 대한 연구 = Tumor-Associated Hypercalcemia

다국어 초록 (Multilingual Abstract)

Tumor-associated hypercalcemia is a common and important clinical problem. Two major pathogenic mechanisms appear to be operative in this disorder:local osteolytic hypercalcemia and humoral hypercalcemia of malignancy. We experienced 20 cases of tumor-associated hypercalcemia from January 1987 to september 1989 and reviewed their clinical findings. The results were as follows;
1) The age ranged from 30 to 79 years with mean age of 57.5 and a male predominance was observed(M:F=3:1).
2. The frequent primary sites of tumor were lung(35％), kidney(20％), esophagus(10％), breast(10％), cervix(10％) and the pathologic findings were squamous cell carcinomas(50％) and renal cell carcinoma(20％).
3) Out of 20 cases, 18 were stage Ⅳ and 2 were Ⅲ. Bone metastasis was observed in 11 cases(55％) and out of 10 cases of squamous cell cancer, only 3 cases showed bone metastasis.
4) The most frequent earliest symptoms were anorexia(90％), constipation(50％), nausea/vomiting(40％) and abdominal pain(35％), and neurologic symptoms as muscle weakness, lethargy, confusion and coma were developed also.
5) Common laboratory findings were moderate to severe hypercalcemia(90％), normal phosphours level(80％), alkaline phosphatase elevation(50％), with 3 liver metastasis, 2 osteoblastic bone metastasis and 5 mixed bone metastasis.
6) On ECG, shortened QTc interval was noted in 35％.
7) Saline diuresis was initial therapy in all 20 cases, steroid was given concomitantly in 5 of them, calcitonin with oral phosphate were given concomitantly in 3 of them and mithramycin was given in only 1 case.
8) 14 cases were died and others were survived more than 6 months.
The results suggest that squamous cell carcinoma, renal cell carcinoma, breast cancer and multiple myeloma are relatively common causes of malignancy associated hypercalcemia and hypercalcemia generally represents a late complication in the course of neoplasia as extensive tumor burden.