Immunochemical characterization of circulating parathyroid hormone⇓related protein in patients with humoral hypercalcemia of cancer

Tumors from patients with humoral hypercalcemia of cancer produce a parathyroid Hormone-Related protein (PTHRP). We have developed two region-specific immunoassays capable of measuring PTHRP in plasma: an immunoradiometric assay directed toward PTHRP amino acid sequence 1 to 74 and a radioimmunoassay directed toward PTHRP amino acid sequence 109 to 138. Sixty normal subjects had low or undetectable plasma PTHRP(1 to 74) concentrations (mean, 1.9 pmol per liter) and undetectable PTHRP(109 to 138) concentrations (<2.0 pmol per liter). Patients with humoral hypercalcemia of cancer (n = 30) had elevated levels of both PTHRP(1 to 74) (mean, 20.9 pmol per liter) and PTHRP(109 to 138) (mean, 23.9 pmol per liter). The plasma concentrations of immunoreactive PTHRP correlated with the levels of urinary cyclic AMP excreted; in some patients, the concentrations decreased after the tumors were resected. Patients with chronic renal failure (n = 15) had plasma PTHRP(1 to 74) concentrations similar to those in the normal subjects, but their plasma PTHRP(109 to 138) concentrations were elevated (mean, 29.6 pmol per liter). The levels of both peptides were normal in patients with hyperparathyroidism and those with hypercalcemia due to various other causes. Breast milk contained high concentrations of PTHRP. An anti-PTHRP(1 to 36) immunoaffinity column failed to extract PTHRP(109 to 138) immunoactivity from plasma, suggesting that the C-terminal region circulates as a separate peptide. We conclude that plasma PTHRP concentrations are high in the majority of patients with cancer-associated hypercalcemia and that the circulating forms of PTHRP in such patients include both a large N-terminal (1 to 74) peptide and a C-terminal (109 to 138) peptide. Measuring the concentrations of PTHRPs may be useful in the differential diagnosis of hypercalcemia. (N Engl J Med 1990; 322:1106–12.).