Calcitriol-Mediated Hypercalcemia: Causes and Course in 101 Patients

Donovan, Peter; Sundac, Lana; Pretorius, Carel J.; d’Emden, Michael C; McLeod, Donald S A

doi:10.1210/jc.2013-2016

Cited by 60 publications

(56 citation statements)

References 28 publications

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“…Of those reported, only one was a neuroendocrine tumour 5. Nonetheless, an Australian retrospective case series of patients with calcitriol-mediated hypercalcaemia found that 5% of cases were associated with solid tumours 2. This evidence suggests that overproduction of 1,25(OH) 2 D may be an under-reported cause of hypercalcaemia in patients with solid malignancies and a comprehensive work-up should be performed for these patients, especially as this could have implications for management.…”

Section: Discussionmentioning

confidence: 99%

Twist on a classic: vitamin D and hypercalcaemia of malignancy

et al. 2017

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Malignancy is the most common cause of hypercalcaemia in the inpatient setting. Most cases are caused by tumour production of parathyroid hormone-related protein and osseous metastases. In less than 1% of cases, hypercalcaemia is driven by increased production of 1,25-dihydroxyvitamin D (1,25(OH)D), a mechanism most commonly seen in haematological malignancies. Here, we describe a woman with metastatic small cell cervical carcinoma who developed hypercalcaemia secondary to paraneoplastic overproduction of 1,25(OH)D, a finding that, to our knowledge, has not been previously associated with this cancer. We also review the current cases of solid tumours reported to have this mechanism of hypercalcaemia and the evidence behind multiple therapeutic approaches.

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Section: Discussionmentioning

confidence: 99%

Twist on a classic: vitamin D and hypercalcaemia of malignancy

et al. 2017

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“…A retrospective case series found that of 101 patients with hypercalcaemia and elevated or inappropriate normal calcitriol, sarcoidosis was the most common aetiology (49%). Haematological malignancy was second at 17%, with infections at 8% 5. A much less common aetiology of hypercalcaemia is from silicone injections.…”

Section: Discussionmentioning

confidence: 99%

Calcitriol mediated hypercalcaemia with silicone granulomas due to cosmetic injection

et al. 2016

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We present a case of a 41-year-old woman with medical history significant for urolithiasis presenting to our hospital for psychiatric evaluation due to worsening depression and suicidal ideations for the past 2 weeks. Initial laboratory results show hypercalcaemia of 13.5 mg/mL that led to consulting internal medicine. On further questioning, the patient admitted to cosmetic silicone injections in her buttocks which were causing calcium deposition under her skin, leading to disfigurement of the sacrum and lumbar regions. She underwent further evaluation with CT and laboratory testing, which effectively ruled out malignancy and primary hyperparathyroidism. The hypercalcaemia was diagnosed as non-PTH-dependent with high levels of 1,25-dihydroxyvitamin D and low PTH. She eventually underwent tissue biopsy confirming the presence of silicone granulomas responsible for the calcitriol-mediated hypercalcaemia. This case reminds one to keep a broad differential especially in patients with hypercalcaemia in which malignancy and primary hyperparathyroidism have been ruled out.

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“…By inhibiting 1-alpha-hydroxylase, steroids (hydrocortisone, prednisone) will prevent the conversion of precursor 25-hydroxyvitamin D into calcitriol [8]. Additionally, in such cases of vitamin D-mediated hypercalcemia, restriction of dietary calcium is needed.…”

Section: Long-standing Treatment Strategies For Hcmmentioning

confidence: 99%

“…Excessive calcitriol production by tumor cells leads to an increased absorption of both calcium and phosphorus from the intestinal tract and osteoclastmediated bone resorption [8]. An even more rarely reported cause of HCM is the ectopic production of authentic PTH by tumoral cells [1,9].…”

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confidence: 99%

Denosumab: A New Agent in the Management of Hypercalcemia of Malignancy

Thosani

2015

Future Oncol.

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Hypercalcemia of malignancy is an oncologic emergency due to tumoral factors that stimulate osteoclast-mediated bone resorption. It requires a combination of recommended treatments (i.e., hydration, bisphosphonate and calcitonin), which may be deleterious in patients with compromised cardiac or renal function or may not control serum calcium levels long term. Recurrent or refractory hypercalcemia may preclude the use of chemotherapeutic agents needed to effectively treat the underlying cancer, which is the cause of hypercalcemia. Denosumab, a fully human monoclonal antibody against RANKL, inhibits the maturation, function and survival of osteoclasts. An open-label, single-arm study of denosumab in patients with hypercalcemia of malignancy despite recent bisphosphonate treatment revealed positive results. Thus, the US FDA recently approved denosumab for the indication of hypercalcemia of malignancy, increasing the options available for patients with this debilitating and life-threatening condition.

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Calcitriol-Mediated Hypercalcemia: Causes and Course in 101 Patients

Abstract: Hypercalcemia mediated by calcitriol remains a rare presentation. In almost half the cases, sarcoidosis was the underlying cause, whereas a third of patients had cancer or systemic infections.

Cited by 60 publications

References 28 publications

Twist on a classic: vitamin D and hypercalcaemia of malignancy

Twist on a classic: vitamin D and hypercalcaemia of malignancy

Calcitriol mediated hypercalcaemia with silicone granulomas due to cosmetic injection

Denosumab: A New Agent in the Management of Hypercalcemia of Malignancy

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