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Parathyroid hormone-related protein (PTHrP) can simulate most of the actions of parathyroid hormone (PTH) including increases in bone resorption and distal tubular calcium reabsorption and inhibition of proximal tubular phosphate transport.1 The low serum phosphate in parallel with low circulating PTH is consistent with PTHrP involvement in this case. Whether it can be causative for a serum calcium of 6.24 mmol/L however is a moot point. While the mechanism underlying the patient’s severe hypercalcaemia proposed by the authors is plausible, the evidence provided for PTHrP being at the root cause is not definitive. The significant differences in mRNA and PTHrP protein fragments reported between neoplastic and normal tissue does not inform on its functional status; it could be …
Handling editor Tahir S Pillay.
Contributors PJT was invited to provide the commentary and conceived the original idea. After discussion with PJT, MK further developed the idea and drafted the first version of the manuscript with subsequent input from all the authors. All authors provided critical feedback and helped shape the analysis and contributed to the development of each version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.