Rare Case of a Patient Presenting with Parathyroid Hormone-Related Peptide Mediated Hypercalcemia and IgG Heavy Chain Disease: Case Report and Review of Literature

IgG Heavy Chain Disease (γHCD) is a rare plasma cell disorder. Hypercalcemia related to plasma cell dyscrasias is related to non-PTHrP related mechanisms. Here we describe the first case of a patient with γHCD and PTHrP related hypercalcemia. Methods: Patient case derived from chart review from 2011 to 2015. Literature review performed searching PubMed 1968-current. Results: The patient was diagnosed with hypercalcemia with elevated PTHrP and exclusion of other etiologies of hypercalcemia. She was diagnosed with (γHCD) by M-spike 0.64 g/dL, IFE showing a broad band of IgG heavy chain, without associated light chains and severe depression of the non-mono-clonal IgG. Serum immunoglobulins demonstrated elevated IgG (2110 mg/dL), normal IgA (46 mg/dL) and decreased IgM (<21 mg/dL). Bone marrow biopsy showed 5% PCs, non-clonal by kappa/lambda, but exclusive for IgG by IHC, without any staining for IgA or IgM. The patient was started on therapy with improved hypercalcemia and PTHrP levels. Conclusions: This is the first reported case of γHCD presenting with PTHrP related hypercalcemia. Given that skeletal involvement is uncommon in γHCD, hypercalcemia secondary to γHCD may at times be a PTHrP driven phenomenon and we recommend that this test be ordered in such cases.

First report of small cell lung cancer with PTHrP-induced hypercalcemic pancreatitis causing disconnected duct syndrome

Here we report a patient diagnosed with small cell lung cancer after first presenting with parathyroid hormonerelated peptide-induced hypercalcemic pancreatitis and developed walled-off necrosis that resulted in disruption of the main pancreatic duct.Disconnected duct syndrome (DDS) is a rare syndrome that occurs when the main pancreatic duct exocrine flow is disrupted resulting in leakage of pancreatic enzymes and further inflammatory sequela.To date,no prior reports have described DDS occurring with paraneoplastic reactions.Diagnostic imaging techniques and therapeutic interventions are reviewed to provide insight into current approaches to DDS.

动态压应力对生长板软骨前体干细胞PTHrP及细胞外基质mRNA表达的影响

目的 研究动态压应力对体外培养的大鼠生长板软骨前体干细胞甲状旁腺激素相关肽（PTHrP）以及软骨特性细胞外基质mRNA表达的影响.方法 免疫磁珠分选并体外培养大鼠软骨前体干细胞,用自行设计制作的可控细胞压力加载装置对细胞进行不同强度（30 mmHg、60 mmHg、90mmHg）和持续时间（1 h、6 h、24 h）的压应力刺激,未刺激组为对照组,采用逆转录-聚合酶链反应（RT-PCR）技术分别检测各组细胞的PTHrP以及软骨特性细胞外基质（Ⅱ型胶原、X型胶原以及aggreean）mRNA表达并进行半定量分析.结果 生长板软骨前体干细胞在30 mmHg、60 mmHg、90 mmHg动态压力培养环境下,各时间点PTHrP、Ⅱ型胶原以及aggrecan mRNA表达水平明显增强并高于对照组（P〈0.05）;Ⅱ型胶原以及aggrecan mRNA表达水平于6h达高峰,PTHrP mRNA的表达水平随时间增加而增强,24 h仍有较高水平的表达;且压力值越大,相同时间点mRNA相对表达量越高.X型胶原表达水平较低且与对照组比较差异无统计学意义（P〉0.05）.结论 适当的动态压应力能有效促进体外培养的大鼠软骨前体干细胞Ⅱ型胶原及aggreean mRNA表达,PTHrP在此力学信号转导过程中可能起重要的作用.

甲状旁腺素相关肽诱导的局部骨吸收及高钙血症动物模型特点

目的研究甲状旁腺素相关肽(PTHrP)诱导的局部骨吸收及高钙血症动物模型特点。方法于小鼠颅骨注射PTHrP9μg/10μL,每日2次。注射前、注射1d、注射3d、注射5d的不同时间内检测血钙水平;注射3d及5d的不同时间内取材,行X线检查和组织学检查。结果注射PTHrP3d后出现高钙血症(>2.0mmol/L),维持3～6h,10h后下降犤(1.50±0.10)mmol/L犦,正常水平为(1.11±0.09)mmol/L;注射PTHrP5d后3h再次上升犤(2.05±0.34)mmol/L犦,10h后下降犤(1.50±0.16)mmol/L犦。骨吸收在注射3d后的24h明显犤(6.839±1.974)mm2犦,注射5d后更为明显犤(22.751±7.090)mm2犦。结论PTHrP诱导的局部骨吸收动物模型最短取材时间以注射3d后的24h为宜,血钙水平的变化呈波动性变化。