Primary hyperparathyroidism and chronic lymphocytic leukemia

Abstract

Although hypercalcemia is a frequent event during the course of many malignancies it has only rarely been described with patients with chronic lymphocytic leukemia. Review of the literature revealed only eleven such case reports. The mechanism of the hypercalcemia in these patients was generally unclear although one patient was found to have a parathyroid adenoma and in another patient tested the level of osteoclast activating factor was high. Two additional chronic lymphocytic leukemia patients with hypercalcemia are described in this report and in each a parathyroid adenoma was found. The patient in whom the diagnosis was made ante mortem had an excellent response to parathyroidectomy. Osteoclast activating factor level was measured in one patient and found to be within normal limits. Since three of the thirteen reported cases of chronic lymphocytic leukemia with hypercalcemia have demonstrated parathyroid adenomas, it is suggested that consideration be given to that possibility in such patients so that appropriate surgery may be done.

Is primary hyperparathyroidism a pathogenic factor in some conditions mediated by B lymphocytes hyperactivity?

“…Several conditions showing hyperparathyroidism and B-cell hyperactivity have been reported. Diverse hematological diseases as chronic lymphocytic leukemia [34], gammapathy of undetermined significance [7,35,36], multiple myeloma [37][38][39], and autoimmune diseases such as systemic lupus erythematosus [40], antiphospholipid syndrome [41], rheumatoid arthritis [42], celiac disease [43], Sjögreń s syndrome [8], Graves disease [44,45], myasthenia gravis [46], polymyositis [47,48] vasculitis [49,50], the association of autoimmune pancreatitis, sclerosing cholangitis and possible autoimmune hypoglycemia [9], anemia and thrombocytopenia are some of the examples found in the literature [11]. Most cases reported refer only to the clinical association without showing the response to hyperparathyroidism treatment.…”

Effects of Parathyroid Hormone on Immune Function

“…Similarly, there have been reports of an increase in the incidence of leukemia [27] and monoclonal gammopathy [28] in patients with primary hyperparathyroidism. Though these observations could not be definitively linked to excess PTH, the concept that PTH may modulate the immune response was further supported by Perry et al [29] in describing a receptor for PTH in circulating human lymphocytes.…”

Hypercalcemia in chronic lymphatic leukemia patients

“…Our literature review revealed only a few case reports in which the mechanism of hypercalcemia was either hyperparathyroidism [2] or cryptogenic [3]. The purpose of this study was to evaluate the incidence of hypercalcemia in CLL and to determine the clinical significance of this finding.…”