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Parathyroid Hormone-Related Peptide 

  • Author: Benjamin Daniel Liess, MD; Chief Editor: Eric B Staros, MD  more...
 
Updated: Jan 30, 2014
 

Reference Range

No detectable (or minimal) parathyroid hormone-related protein (PTHrP) is normal.

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Interpretation

Over the last 20-25 years, our understanding of PTH-rP has magnified along with our ability to discern the role PTH in multiple physiologic and pathologic conditions. PTH-rP production and action, along with the complex role it plays in cancer, is just beginning to be understood. PTH-rP is widely distributed in the human body and has broad roles in the endocrine, paracrine, and intracrine systems, which affect a multitude of physiologic and pathologic conditions, along with playing a central role in organogenesis.[1, 2]

PTH-rP resembles PTH in as much as they bind to the same type 1 PTH/PTHrP receptor and induce a similar response in the body. For this reason, hypercalcemia of malignancy resembles hyperparathyroidism and has been historically labeled a paraneoplastic syndrome. One of the many effects PTH-rP may have on the body is the induction of hypercalcemia; thus, hypercalcemia of malignancy might warrant an evaluation of PTH-rP levels.

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Collection and Panels

Collection

See the list below:

  • Specimen - Blood
  • Container - Lavender (EDTA) or pink (K2 EDTA); collect in chilled container
  • Collection method - Routine venipuncture

Panels

PTH-rP is not typically a part of a panel and should be ordered specifically.

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Background

Description

PTH-related peptide is produced by some cancers, including those of the lung, breast, head, neck, bladder, gastrointestinal tract, and ovaries, as well as leukemia and lymphoma. High levels of PTH-related protein may be the cause of elevated calcium levels in many cancer patients. This condition is referred to humoral hypercalcemia of malignancy (HHM). Since PTHrP has the same N-terminal as PTH, it can bind to the same receptor and stimulate the action of PTH. This results in bone resorption and calcium resorption in the kidneys, but has minimal effect on calcium absorption in the intestines. Additionally, PTHrP has multiple proposed normal roles, including fetal calcium regulation during development, placental calcium transfer, lactation, dental eruption, smooth muscle relaxation, and epithelial cell growth.[3, 4, 5, 6, 7, 1]

Indications/Applications

PTHrP may be evaluated in patients with hypercalcemia associated with malignancy. It may also be monitored as a tumor marker during the treatment phase of disease. Current research is exploring applications of the administration of PTH-rP as treatment for several diseases, including breast cancer, diabetes, and osteoporosis.[1]

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Contributor Information and Disclosures
Author

Benjamin Daniel Liess, MD Assistant Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Benjamin Daniel Liess, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, The Triological Society, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

References
  1. Wysolmerski JJ. Parathyroid hormone-related protein: an update. J Clin Endocrinol Metab. 2012 Sep. 97(9):2947-56. [Medline]. [Full Text].

  2. McCauley LK, Martin TJ. Twenty-five years of PTHrP progress: from cancer hormone to multifunctional cytokine. J Bone Miner Res. 2012 Jun. 27(6):1231-9. [Medline].

  3. Moseley JM, Gillespie MT. Parathyroid hormone-related protein. Crit Rev Clin Lab Sci. 1995. 32(3):299-343. [Medline].

  4. Broadus AE, Mangin M, Ikeda K, Insogna KL, Weir EC, Burtis WJ, et al. Humoral hypercalcemia of cancer. Identification of a novel parathyroid hormone-like peptide. N Engl J Med. 1988 Sep 1. 319(9):556-63. [Medline].

  5. Ninnenson RA. Parathyroid Hormone-Related Protein. Reviews in endocrine and metabolic disorders. No. 4. 2000. Vol. 1: 343-352.

  6. Jasti P, Lakhani VT, Woodworth A, Dahir KM. Hypercalcemia secondary to gastrointestinal stromal tumors: parathyroid hormone-related protein independent mechanism?. Endocr Pract. 2013 Nov-Dec. 19(6):e158-62. [Medline].

  7. Longo A, Librizzi M, Naselli F, Caradonna F, Tobiasch E, Luparello C. PTHrP in differentiating human mesenchymal stem cells: transcript isoform expression, promoter methylation, and protein accumulation. Biochimie. 2013 Oct. 95(10):1888-96. [Medline].

  8. Hens JR, Dann P, Zhang JP, Harris S, Robinson GW, Wysolmerski J. BMP4 and PTHrP interact to stimulate ductal outgrowth during embryonic mammary development and to inhibit hair follicle induction. Development. 2007 Mar. 134(6):1221-30. [Medline].

  9. Parathyroid Hormone-Related Peptide (PTHrP). ARUP Laboratories. Available at http://www.aruplab.com/guides/ug/tests/0093014.jsp. Accessed: 5/18/2012.

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