The Savage Case: What can we Learn?

production of vitamin Ddike compounds and osteolytic steroids, may also playa role in some patients. Hypercalcaemia in malignancy due to production of ectopic parathyroid hormone (pseudohyperparathyroidism) is being recognized with increasing frequency, and is usually associated with the histological type either squamous carcinoma or squamous differentiation rather than the site of the tumour2•6•7• To establish the diagnosis of pseudohyperparathyroidism, there should be no radiologicalor autopsy evidence of bony metastases, the parathyroid glands should be normal, and serum calcium and serum phosphate levels should resemble primary hyperthyroidism". In our patient these criteria were established, and we believe the tumour may have been producing ectopic parathormone or similar material resulting in hypercalcaemia. Unfortunately, immunological techniques were not readily available at our centre to confirm this. Hypercalcaemia in malignancy may be incidental and asymptomatic or may require urgent therapy". It has potentially serious consequences if not identified and corrected promptly, as occurred in our case. More cases will need to be studied to clarify whether the occurrence of hypercalcaemia in squamous cell carcinoma of the stomach is a surprising finding or one to be expected.