Journal List > J Korean Endocr Soc > v.23(3) > 1003437

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Chun, Kim, Yun, Jang, Park, Cho, Ko, Ahn, Suh, and Kim: Two Cases of Primary Hyperparathyroidism Associated with Colon Cancer
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2008; 23(3): 204-209.

Published online: 20 June 2008

DOI: https://doi.org/10.3803/jkes.2008.23.3.204

Two Cases of Primary Hyperparathyroidism Associated with Colon Cancer

Sang Hoon Chun, Yun Kyung Kim, Jae-Seung Yun, Eun Hee Jang, Shin-Ae Park, Jae Hyung Cho, Seung-Hyun Ko, Yu-Bai Ahn, Young-Jin Suh1, Jun-Gi Kim1

Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea.

1Department of Surgery, The Catholic University of Korea, College of Medicine, Korea.

Received 26 February 2008       Accepted 7 April 2008

Copyright © 2008 Korean Endocrine Society

Abstract

Hypercalcemia is often observed in cancer patients secondary to parathyroid hormone (PTH) related peptide production. However, primary hyperparathyroidism and colon cancer rarely present simultaneously. Calcium is believed to have a chemopreventive effect against colorectal cancer because it reduces crypt cell hyperproliferation in both humans and in animals. There is evidence to suggest that the incidence of colorectal cancer in humans is reduced by high calcium intake. In patients with primary hyperparathyroidism, increased PTH activates 1,25(OH)2D and enhances calcium absorption in the gut. Consequently, the calcium level in the lumen is decreased, leading to an elevated risk of colorectal cancer. We report two patients with colon cancer and hypercalcemia secondary to primary hyperparathyroidism, along with a brief review of the literature.

Keywords: colonic neoplasms, hypercalcemia, hyperparathyroidism

Figures and Tables

Fig. 1
1-1. Thyroid sonography finding showed 1.3 × 0.85 cm sized heterogenous low echogenic mass in the lower pole of right thyroid lobe.
1-2. 99mTc-sestamibi scan showed no increased abnormal radioactivity in (A) early image (10 minutes), however, there was a hot uptake in the lower pole of right thyroid bed suggested parathyroid adenoma in (B) delayed image (2 hours, in black arrow).
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Fig. 2
Abdominal CT showing about 1.8 cm sized well enhancing mass was noted in the right adrenal gland(black arrow).
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Fig. 3
(A) Well differentiated adenocarcinoma of colon is seen, in which the glands are much larger and have irregular shape (×200, H&E stain). (B) Histologic finding of removed parathyroid gland showed encapsulated, cellular, homogenous lesions composed of chief cells with some oxyphil cells in a delicate capillary network (×200, H&E stain).
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Fig. 4
4-1. Thyroid sonography showed 1cm sized oval shape nodule in right upper lobe.
4-2. 99mTc-Sestamibi scan showed no increased abnormal radioactivity in early image (10 minutes) (A). But there was a focal delayed washout of radiotracer is noted in lower portion of right thyroid bed (2 hours, in black arrow) (B).
jkes-23-204-g004
Fig. 5
Microscopically, a moderately differentiated adenocarcinoma of colon is seen here. There is a glandular configuration, but the glands are irregular and crowded (×200, H&E stain).
jkes-23-204-g005

References

1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. 2005. 16th ed. New York: McGraw-Hill;2252.
2. Stewart AF. Hypercalcemia Associated with Cancer. N Engl J Med. 2005. 352:373–379.
3. Farr HW, Fahey TJ, Nash AG, Farr CM. Primary hyperparathyroidism and cancer. Am J Surg. 1973. 126:539–543.
4. Kawamura YJ, Kazama S, Miyahara T, Masaki T, Muto T. Sigmoid colon cancer associated with primary hyperparathyroidism: Report of a Case. Surg Today. 1999. 29:789–790.
5. Lipkin M, Reddy B, Newmark H, Lamprecht SA. Dietary factors in human colorectal cancer. Annu Rev Nutr. 1999. 19:545–586.
6. Milner JA, McDonald SS, Anderson DE, Greenwald P. Molecular targets for nutrients involved with cancer prevention. Nutr Cancer. 2001. 41:1–16.
7. Holt PR, Wolper C, Moss SF, Yang K, Lipkin M. Comparison of calcium supplementation or low-fat dairy foods on epithelial-cell proliferation and differentiation. Nutr Cancer. 2001. 41:150–155.
8. Nobre LC, Chaves P, Fidalgo P, Cravo M, Gouveia OA, Ferra M, Mira F. Calcium regulation of colonic crypt cell kinetics: evidence for a direct effect in mice. Gastroenterology. 1995. 109:498–504.
9. Kallay E, Kifor O, Chattopadhyay N, Brown EM, Bischof MG, Peterlik M, Cross HS. Calcium-dependent c-myc proto-oncogene expression and proliferation of Caco-2 cells: a role for a luminal extracellular calcium-sensing receptor. Biochem Biophys Res Commun. 1997. 232:80–83.
10. Sergio A, Lamprecht , Lipkin M. Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nature Reviews Cancer. 2003. 3:601–614.
11. Bilezikian JP, Silverberg SJ. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004. 350:1746–1751.
12. Newmark HL, Wargowich MJ, Bruce WR. Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst. 1984. 72:1323–1325.
13. Buras RR, Shabahang M, Davoodi F, Schumaker LM, Cullen KJ, Byers S, Nauta RJ, Evans SR. The effect of extracellular calcium on colonocytes: evidence for differential responsiveness based upon degree of cell differentiation. Cell Prolif. 1995. 28:245–262.
14. Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF. Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med. 2007. 32:210–216.
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