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 P...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.展开更多
目的探讨间歇性甲状旁腺激素相关蛋白(parathyroid hormone related protein,PTHrP)刺激在成牙骨质细胞中对细胞凋亡和成牙骨质矿化相关蛋白和细胞因子表达的影响。方法应用成牙骨质细胞OCCM-30,使用PTHrP(1-36)、甲状旁腺激素I型受体(p...目的探讨间歇性甲状旁腺激素相关蛋白(parathyroid hormone related protein,PTHrP)刺激在成牙骨质细胞中对细胞凋亡和成牙骨质矿化相关蛋白和细胞因子表达的影响。方法应用成牙骨质细胞OCCM-30,使用PTHrP(1-36)、甲状旁腺激素I型受体(parathyroid hormone type I receptor,PTH1R)阻断剂PTHrP(7-34)对细胞进行间歇性刺激,间歇性给药模式包含3个周期,48 h/周期,分为对照组、PTHrP(1-36)组及PTH1R阻断剂组。采用流式细胞术检测细胞凋亡;采用茜素红染色观察矿化功能;采用real-time PCR和Western blotting法检测细胞内成牙骨质矿化相关蛋白-骨桥素(osteopontin,OPN)、I型胶原蛋白(collagen-1,COL-1)及成牙骨质相关细胞因子I型胰岛素样生长因子-1(insulin like growth factor-1,IGF-1)的基因表达及蛋白质表达。结果间断性PTHrP抑制成牙骨质细胞凋亡,PTH1R阻断剂促进成牙骨质细胞凋亡(P<0.05);PTHrP间断性刺激能够显著增加成牙骨质细胞内OPN、COL-1、IGF-1基因及蛋白表达(P<0.05);PTH1R阻断剂抑制成牙骨质细胞内OPN、COL-1、IGF-1基因及蛋白表达(P<0.05)。结论间断性PTHrP可通过与成牙骨质细胞上PTH1R相互作用抑制细胞凋亡,促进成牙骨质细胞矿化以及相关蛋白和细胞因子的表达。展开更多
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 disru...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.展开更多
文摘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.
文摘目的探讨间歇性甲状旁腺激素相关蛋白(parathyroid hormone related protein,PTHrP)刺激在成牙骨质细胞中对细胞凋亡和成牙骨质矿化相关蛋白和细胞因子表达的影响。方法应用成牙骨质细胞OCCM-30,使用PTHrP(1-36)、甲状旁腺激素I型受体(parathyroid hormone type I receptor,PTH1R)阻断剂PTHrP(7-34)对细胞进行间歇性刺激,间歇性给药模式包含3个周期,48 h/周期,分为对照组、PTHrP(1-36)组及PTH1R阻断剂组。采用流式细胞术检测细胞凋亡;采用茜素红染色观察矿化功能;采用real-time PCR和Western blotting法检测细胞内成牙骨质矿化相关蛋白-骨桥素(osteopontin,OPN)、I型胶原蛋白(collagen-1,COL-1)及成牙骨质相关细胞因子I型胰岛素样生长因子-1(insulin like growth factor-1,IGF-1)的基因表达及蛋白质表达。结果间断性PTHrP抑制成牙骨质细胞凋亡,PTH1R阻断剂促进成牙骨质细胞凋亡(P<0.05);PTHrP间断性刺激能够显著增加成牙骨质细胞内OPN、COL-1、IGF-1基因及蛋白表达(P<0.05);PTH1R阻断剂抑制成牙骨质细胞内OPN、COL-1、IGF-1基因及蛋白表达(P<0.05)。结论间断性PTHrP可通过与成牙骨质细胞上PTH1R相互作用抑制细胞凋亡,促进成牙骨质细胞矿化以及相关蛋白和细胞因子的表达。
文摘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.
