RICHARD N. DEXTER, M.D., F.A.C.P.; FRANKLIN MULLINAX, M.D.; HERSCHEL L. ESTEP, M.D.; RALPH C. WILLIAMS JR., M.D., F.A.C.P.
Three patients with hypercalcemia had serum IgG monoclonal gammopathies. In none of the cases could a diagnosis of multiple myeloma be established, and other clinical findings were most compatible with primary hyperparathyroidism. Parathyroid exploration showed a parathyroid adenoma in two patients and parathyroid hyperplasia in the third. The hypercalcemia but not the gammopathy disappeared after removal of abnormal parathyroid tissue in all three patients. One of the monoclonal IgG proteins was of the kappa type, and two were of the lambda type; no shared idiotypic specificities could be shown. No definite evidence for a specific parathyroid-directed antibody was found by immunofluorescence studies. Clinically, the finding of a monoclonal immunoglobulin pattern in a patient with hypercalcemia does not necessarily indicate multiple myeloma, nor does it exclude primary hyperparathyroidism.
DEXTER RN, MULLINAX F, ESTEP HL, WILLIAMS RC. Monoclonal IgG Gammopathy and Hyperparathyroidism. Ann Intern Med. ;77:759–764. doi: 10.7326/0003-4819-77-5-759
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Published: Ann Intern Med. 1972;77(5):759-764.
Endocrine and Metabolism, Parathyroid Disorders.
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