Paratiroid Hormon İlişkili Proteine Bağlı Malin Hiperkalsemiyle Başvuran Meduller Tiroid Karsinomu Olgusu

Abstract

Burada boyunda kitle ve diyare ile başvuran 50 yaşında bir erkek hastayı sunduk. Kitleden alınan eksizyonel biopsi örneğinin histolojik incelemesinde meduller tiroid karsinomu saptandı. Gelişindeki laboratuvar tetkiklerinde belirgin hiperkalsemi saptanan hastanın serum paratiroid hormon (PTH) düzeyi <1 pg/ml (normal: 10-69), PTH-ilişkili protein (PTHrP) düzeyi ise 8.5 pmol/L (normal: <1.3) bulundu, ayrıca karaciğerde metastaz saptandı, kemik metastazı tespit edilmedi. Kemoterapi başlanan hastanın durumu progressif olarak kötüleşti ve solunum yetmezliği nedeniyle kaybedildi. Olgumuz literatürde PTHrP üretimine bağlı malign humoral hiperkalseminin nedeni olarak bildirilen ilk meduller tiroid karsinomu olgusudur.

We present the case of a 50-year-old male patient presenting with a mass lesion in the neck region and diarrhea. Histological examination of the excisional biopsy specimen revealed medullary thyroid carcinoma. In the laboratory examination of the patient marked hypercalcemia was detected along with a low parathyroid hormone (PTH) levels (<1 pg/ml, (normal range: 10-69 pg/ml). PTH-related protein (PTHrP) level was elevated (8.5 pmol/L, normal range: <1.3 pmol/L). An extensive metastasis screening found metastatic lesions in the liver while no bone metastasis was discovered. The patient died shortly after induction of chemotherapy due to respiratory failure. To the best of our knowledge, this is the first reported case of a PTHrP-producing medullary carcinoma of the thyroid associated with humoral hypercalcemia of malignancy.