Hypercalcemia and Increased Parathyroid-Hormone Activity in a Primary Hepatoma

Abstract

A patient with hypercalcemia associated with a carcinoma of the intrahepatic bile ducts showed some decrease in serum calcium after a course of prednisone. Orthotopic liver transplantation was followed by a further fall in serum calcium, and the urinary excretion of calcium and hydroxyproline returned to normal. The circulating concentration of immunoassayable parathyroid hormone was elevated before and fell to normal after transplantation. Parathyroid hormone was demonstrated in extracts of the resected tumor. At operation arteriovenous and venovenous gradients across the liver suggested that the hepatic tumor was actively secreting a parathyroid-hormone–like polypeptide into the circulation.