A Case of Primary Hyperparathyroidism with Castration Resistant Prostate Cancer

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  • 去勢抵抗性前立腺癌を伴った原発性副甲状腺機能亢進症の1例
  • キョセイ テイコウセイ ゼンリツセンガン オ トモナッタ ゲンパツセイ フクコウジョウセン キノウ コウシンショウ ノ 1レイ

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Abstract

<p>An old man presented with right coxalgia. Advanced prostate cancer with pubic bone and pelvic lymph node metastases was suspected with CT and MRI findings. Laboratory analysis revealed elevated PSA concentration (219 ng/ml) and hypercalcemia (10.8 mg/dl). We simultaneously performed a prostate biopsy and castration in combined androgen blockade (CAB) therapy. The histopathological diagnosis was prostate cancer. Considering slightly enlarged bone metastasis on CT and increased PSA lavel, we made the diagnosis of castration resistant prostate cancer (CRPC) two years four months after initiation of CAB therapy. After two years seven months CAB therapy, treatment of hypercalcemia with zoledronic acid decreased the serum PSA level, but the serum high calcium level persisted. He was referred to our office for evaluation of high serum intact-PTH level (99.2 pg/ml). Bone mineral density measurement of the femoral bone was decreased. Ultrasonography of the neck and contrast-enhanced CT revealed no parathyroid adenoma. Parathyroidectomy was performed following identification of the dissection area during surgery. CRPC with bone metastasis should be pointed out as a causative disease of hypercalcemia, but we think that primary hyperparathyroidism should always be suspected when hypercalcemia is recognized in advanced cancer patients.</p>

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