高Prostaglandin性高Ca血症を伴う悪性褐色細胞腫の1例

Abstract

A 52-year-old male was referred from orthopedic surgery in October 1979, who visited with the chief complaint of right hip pain. Osteolytic change was seen in right iliac, pubic and cranial bones on X-ray films and were diagnosed a metastatic lesion by iliac bone biopsy. Abdominal aortic angiography and computed tomography revealed a hypervascular and soft tissue mass in left adrenal gland. Serum and urine norepinephrine were 5.01 ng/ml (N =0.04-0.35 ng/ml) and 1050, ug/24h (N = 10.0-90.0 µg/24h). A diagnosis was made as malignant pheochromocytoma with multiple bone metastases. At the time of admission to our urologic department, serum Ca was 13.3 mg/dl and hypercalcemia was treated with eel-calcitonin and predonine but serum Ca level was not decreased. Serum prostaglandin-Es was as high as 591 pg/ml (N<320 pg/ml) and then a potent inhibitor of prostaglandin synthesis (indomethacin: 100 mg/day orally) was administrated for 3 days. Prostaglandin-Es and serum Ca were decreased to 20 pg/ml and 8.3 mg/ml respectively. Serum parathyroid hormone and nephrogenous cyclic-AMP were within normal range. It might be throught that the hypercalcemia of this patient was caused by prostaglandin-Es. The patient has been well controlled for 6 months as an out-patient by indomethacin (40 mg/day orally) and phenoxybenzamine (40 mg/day orally), the anti-hypercalcemic and anti-hypertensive agents respectively. He developed a mechanical ileus caused by obstruction of transverse colon invaded by malignant pheochromocytoma, and then progressed to septic shock. He died on May 6, 1980. There were no hyperplasia or adenoma in the parathyroid. The thyroid gland showed no abnormal change. The histological finding of metastatic bone lesion of the right ilium was same as malignant pheochromocytoma of the left adrenal gland on necropsy.