Hypocalcaemic response to streptomycin in malignant hypercalcaemia.

Introduction Malignant hypercalcaemia (pseudohyperparathyroidism) is occasionally associated with primary hepatocellular carcinoma (PHC) or cholangio carcinoma which has not metastasized to bone (Becker, Sternberg and Kalser, 1963; Keller, Goldschneider and Lafferty, 1965; Knill-Jones et al., 1970). Normocalcaemia is restored if the tumour is resected or a liver transplant undertaken (Knill-Jones et al., 1970). Generally, treatment of PHC with radiotherapy or chemotherapy has met with little success and the prognosis remains poor (El-Domeiri et al., 1971; Falkson, 1973). In the case reported here, the primary liver cancer was irresectable. The hypercalcaemia proved refractory to treatment with oral phosphates, glucagon and saline infusions, but responded transiently to intra-arterial mitomycin-C and markedly to parenteral streptomycin. The hypocalcaemic effect of streptomycin has been reported from experimental animals (Galante et al., 1970), but not previously from patients with hypercalcaemia.