高カルシウム血症への取り組み



Approach to Hypercalcemia.

Goltzman D(1).
In: Feingold KR(2), Anawalt B(3), Blackman MR(4), Boyce A(5), Chrousos G(6), Corpas E(7), de Herder WW(8), Dhatariya K(9), Dungan K(10), Hofland J(11), Kalra S(12), Kaltsas G(13), Kapoor N(14), Koch C(15), Kopp P(16), Korbonits M(17), Kovacs CS(18), Kuohung W(19), Laferrere B(20), Levy M(21), McGee EA(22), McLachlan R(23), New M(24), Purnell J(25), Sahay R(26), Shah AS(27), Singer F(28), Sperling MA(29), Stratakis CA(30), Trence DL(31), Wilson DP(32), editors.
Author information:
(1)Antoine Massabki Professor of Medicine and Physiology, McGill University and McGill University Health Centre, 1001 Decarie Blvd, Room EM1.3220, Montreal, QC, Canada
(2)Professor of Medicine Emeritus, University of California, San Francisco, CA
(3)Chief of Medicine at the University of Washington Medical Center and Professor and Vice Chair of the Department of Medicine, University of Washington
(4)Sr. Physician Scientist, Washington DC VA Medical Center; Professor of Medicine & Rehabilitation Medicine, Georgetown University; Clinical Professor of Medicine, Biochemistry and Molecular Medicine, George Washington University; and Professor of Medicine (Part-time), Johns Hopkins University
(5)Pediatric Endocrinologist and Associate Research Physician in the Skeletal Diseases and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health
(6)Professor of Pediatrics and Endocrinology, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
(7)M.D. Ph.D in Gerontology. Honorary Professor of Medicine, Universidad de Alcala, Madrid. Consultant in Endocrinology, Hospital HLA Guadalajara (Spain).
(8)Professor of Endocrine Oncology, Erasmus MC and Erasmus MC Cancer Center, Rotterdam, the Netherlands
(9)Consultant in Diabetes, Endocrinology and General Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust and University of East Anglia, Norwich, UK.
(10)Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Ohio State University
(11)Consultant Endocrinologist, Erasmus MC and Erasmus MC Cancer Center, Rotterdam, the Netherlands
(12)Consultant Endocrinologist, Department of Endocrinology, Bharti Hospital, Karnal, India
(13)Professor of General Medicine-Endocrinology, 1st Department of Propaedeutic Medicine, National and Kapodistrian University of Athens, Athens, Greece
(14)Professor of Endocrinology, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Australia.
(15)Professor, The University of Tennessee Health Science Center, Memphis, Tennessee
(16)Professor of Medicine and Chief of the Division of Endocrinology, Diabetology and Metabolism, University of Lausanne, Switzerland
(17)Professor of Endocrinology and Metabolism, Centre Lead for Endocrinology and Deputy Institute Director, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England
(18)University Research Professor and Professor of Medicine (Endocrinology and Metabolism), Obstetrics & Gynecology, and BioMedical Sciences, at Memorial University of Newfoundland in St. John’s, Newfoundland, Canada.
(19)Director of the Division of Reproductive Endocrinology at Boston Medical Center and an Associate Professor of Obstetrics and Gynecology at the Boston University School of Medicine
(20)Professor of Medicine, New York Nutrition Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
(21)Consultant endocrinologist at University Hospitals of Leicester and Honorary Associate Professor at Leicester University
(22)Professor of Obstetrics and Gynecology at the University of Vermont and Director of the Division of Reproductive Endocrinology and Infertility. Burlington, Vermont (23)Director of Clinical Research, Hudson Institute of Medical Research; Consultant Endocrinologist, Monash Medical Centre, Melbourne, Australia (24)Professor of Pediatrics, Professor of Genetics and Genomic Sciences, and Chief of the Adrenal Steroid Disorders Program, Icahn School of Medicine, Mount Sinai School of Medicine, New York, NY (25)Professor of Medicine, Knight Cardiovascular Institute and the Division of Endocrinology, and Associate Director, Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, OR
(26)Professor and Head of Department of Endocrinology, Osmania Medical College and Osmania General Hospital, Hyderabad, India.
(27)Professor of Pediatrics, The University of Cincinnati, Department of Pediatrics and Cincinnati Children’s Hospital Medical Center, Division of Endocrinology, Cincinnati, OH, USA
(28)Director of the Endocrine/Bone Disease Program, Saint Johns Cancer Institute at Saint John’s Health Center, Santa Monica, CA; Clinical Professor of Medicine, UCLA School of Medicine, Los Angeles, CA
(29)Professorial Lecturer, Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, NY. Emeritus Professor and Chair, Department of Pediatrics, University of Pittsburgh.
(30)CSO, ELPEN, Inc. & Director, Research Institute, Athens, Greece & Senior Investigator, Human Genetics & Precision Medicine, FORTH (ITE), Heraklion, Greece. Emeritus Scientific Director & Senior Investigator, NICHD, NIH, Bethesda, MD, USA
(31)Professor of Medicine, Emeritus, University of Washington, Seattle, WA
(32)Endowed Chair, Cardiovascular Health and Risk Prevention, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX
Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.2023 Apr 17.

血清カルシウムの減少は副甲状腺ホルモン放出を刺激し、これが骨吸収を増価させたり、腎臓におけるカルシウム再吸収を亢進させたり、腎臓において25-ヒドロキシビタミンDの活性型1,25-ジヒドロキシビタミンD成分への転換を刺激して腸におけるカルシウム再吸収の増加につながる。このメカニズムは血清カルシウムを正常なレベルに回復させ、副甲状腺ホルモンや1,25-ジヒドロキシビタミンDのさらなる放出を抑制する。総カルシウムの血清中濃度の一般的な正常値は8.5から10.5mg/dL(2.12から2.62mM)であり、カルシウムイオン濃度は4.65-5.30mg/dL(1.16-1.31mM)の範囲にある。副甲状腺ホルモンや1,25-ジヒドロキシビタミンDが原因ではない場合、副甲状腺ホルモンや1,25-ジヒドロキシビタミンDの減少は高カルシウム血症を伴う。高カルシウム血症は以下のような原因で発症する。すなわち、一次性特発性あるいは家族性の副甲状腺機能亢進症(症候性あるいは非症候性)や三次性副甲状腺機能亢進症を含む副甲状腺ホルモンが過剰な内分泌系疾患；甲状腺機能亢進症やクロム親和性細胞腫やVIP産生腫瘍や副腎機能低下症やJansen型骨幹端軟骨異形成を含む副甲状腺ホルモンの過剰分泌がみられない内分泌系疾患；副甲状腺ホルモン関連タンパク質の亢進やその他の原因(例：リンパ腫内での1,25-ジヒドロキシビタミンDの増加)を原因とする悪性関連高カルシウム血症；1,25-ジヒドロキシビタミンDの増加を原因とする可能性がある肉芽腫性疾患やウイルス症候群(ヒト免疫不全ウイルス)を含む炎症性疾患；ウィリアムズ症候群や特発性小児高カルシウム血症などを含む小児症候群で、25-ヒドロキシビタミンD-24-ヒドロキシラーゼ遺伝子(CYP24A1)の突然変異を原因として発生した1,25-ジヒドロキシビタミンDレベルの異常が発生している；サイアザイド系利尿薬、リチウム、ビタミンD、ビタミンA、抗女性ホルモン剤、テオフィリンなどを含む薬物療法；長期間に及ぶ運動抑制、特に骨代謝が激しい状態。治療は原因となる疾患を対象とするが、血清カルシウムが12から14mg/dL(3から3.5mM)を超えている場合、急性水和や骨吸収を抑制する薬剤の投与が必要である。場合によっては、カルシウム受容体刺激薬、尿へのカルシウム排せつ増加、糖質コルチコイド、透析なども必要となる。内分泌学の関連分野を完全にカバーするには、無料のウェブページを参照のこと。

（２０２３年５月）



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