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부갑상선 호르몬 관련 펩티드를 분비하는 간세포암종의 완전 절제
김은경 ( Eun Kyoung Kim ),김진수 ( Jin Su Kim ),신기철 ( Ki Chul Shin ),이길태 ( Gil Tae Lee ),한철주 ( Chul Ju Han ),김상범 ( Sang Beom Kim ),구윤희(교신저자) ( Yun Hyi Ku ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.2
Hepatocellular carcinoma (HCC) is the fifth most common cancer in Korea. Diverse paraneoplastic syndromes can occur in patients with HCC, but parathyroid hormone-related peptide (PTH-rP)-induced hypercalcemia is uncommon. Hypercalcemia due to PTH or particularly PTH-rP-secreting HCC is associated with poor outcomes. We report a 71-year-old man who presented with symptoms of vague abdominal discomfort, somnolence, lethargy, nausea, vomiting, and weight loss. Imaging studies revealed a large HCC without metastasis. The laboratory findings showed elevated serum calcium level, low intact parathyroid hormone (iPTH) level and elevated PTH-rP level. These results led to a diagnosis of a PTH-rP-secreting HCC and paraneoplastic hypercalcemia. After emergency management of the hypercalcemia, the patient underwent an extended right hemihepatectomy with cholecystectomy. One year after the surgery, he is alive with normal calcium, PTH-rP, and iPTH levels. This case demonstrates that the rare phenomenon of life-threatening hypercalcemia caused by HCC should not be overlooked. These symptoms offer a good opportunity to diagnose HCC early. Radical tumor resection makes it possible to cure patients with PTH-rP-secreting HCC. (Korean J Gastroenterol 2015;66:122-126)