Efficacy and safety of pamidronate in children with vitamin D intoxication

Kara, Cengiz; Çeti̇nkaya, Semra; Gündüz, Suzan; Yılmaz, Gülay Can; Aycan, Zehra; Aydın, Murat

doi:10.1111/ped.12875

Cited by 13 publications

(16 citation statements)

References 37 publications

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“…Bisphosphonates have been used in a wide variety of conditions that cause severe hypercalcaemia, 74 with case series/observational data of its use in vitamin D toxicity, 75,76 immobilisation hypercalcaemia 77 and severe neonatal hyperparathyroidism. 78 In addition, case reports are published for its use in subcutaneous fat necrosis, 79 parathyroid hormone related peptide (PTHrP)associated hypercalcaemia of infancy 80 and Williams syndrome.…”

Section: Evidencementioning

confidence: 99%

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Simm

Biggin

Zacharin

et al. 2018

J Paediatrics Child Health

122

118

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Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.

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Section: Evidencementioning

confidence: 99%

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Simm

Biggin

Zacharin

et al. 2018

J Paediatrics Child Health

122

118

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“…Although systemic glucocorticoids are commonly used in the management of severe hypercalcemia, no steroids were administered to our patient because of unknown etiology of hypercalcemia at initial. Besides this, recent studies reveal that pamidronate-disodium is more effective than glucocorticoids in the treatment of children with severe hypercalcemia secondary to vitamin D intoxication or increased vitamin D effects [ 11 , 12 ]. Therefore, pamidronate-disodium can be an effective alternative to glucocorticoids to treat severe hypercalcemia in patients with a suspicion of tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia

Kılınç

Bostan

Erol

et al. 2019

North Clin Istanbul

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Hypercalcemia is a common metabolic abnormality in children and generally occurs due to hyperparathyroidism, vitamin D toxicity, some genetic disorders and malignant diseases. Granulomatous diseases are a rare cause of hypercalcemia in children, which are usually mild and asymptomatic. Severe hypercalcemia in granulomatous diseases has also been reported in the literature. Here, we report a child presenting with severe hypercalcemia secondary to miliary tuberculosis with successful management with bisphosphonate treatment. Increased 1,25(OH)2D3 synthesis by activated macrophages in the granuloma tissue is the major mechanism of hypercalcemia in tuberculosis.

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“…Other treatment regimens for vitamin D intoxication include calcitonin, prednisolone, alendronate, pamidronate, and hemodialysis (3,4) (15). In the present study, nine patients with median calcium and 25(OH)D levels of 17.1 mg/dL and 361 ng/mL, respectively, were started prednisolone [Group 2, 1 (1-2) mg/kg/day, 5 (3-10) days] as first-line treatment.…”

Section: Currently There Are Various Treatment Regimens For Vitamin mentioning

confidence: 94%

“…These data, along with the abovementioned reports, indicate that prednisolone treatment has low efficiency in "severe" hypercalcemia. (11,15). However, in both studies, some of the children compared had received the other treatment regimen previously.…”

Section: Currently There Are Various Treatment Regimens For Vitamin mentioning

confidence: 99%

“…On the other hand, pediatricians are encountering children with mild-to-severe consequences associated with hypercalcemia due to vitamin D intoxication, which is generally defined when serum levels of 25-hydroxyvitamin D are above 100-150 ng/mL (250-375 nmol/L) (1,(3)(4)(5). Possible causes include treatment of vitamin D-deficient rickets with single large (6) or pharmacologic daily doses of vitamin D (7), manufacturing errors of over-the-counter drugs (8,9), parental dosing error (10), overfortification of milk from a home-delivery dairy (11), and prescription of vitamin D without prior measurement of its serum level or definite diagnosis of rickets (12)(13)(14)(15). Treatment options for vitamin D intoxication in children currently include discontinuation of vitamin D intake, intravenous hydration with normal saline, furosemide, glucocorticoids, calcitonin, alendronate, pamidronate, and hemodialysis, mainly based on case reports and small studies (4, 5, 7-10, 12, 13, 15-21).…”

mentioning

confidence: 99%

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Comparison of Treatment Regimens for the Management of Severe Hypercalcemia due to Vitamin D Intoxication in Children

Demır¹,

Doneray²,

Kara³

et al. 2018

Jcrpe

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What is already known on this topic?There are various treatment options for hypercalcemia. Pamidronate treatment efficiently lowers serum calcium levels in children with hypercalcemia due to vitamin D intoxication. What this study adds?This study is the first to compare first-line treatment options for hypercalcemia due to vitamin D intoxication. Children receiving prednisolone for severe hypercalcemia often requires another type of drug treatment. Pamidronate treatment prevents recurrence of hypercalcemia.ABSTRACT Background/Aims: No large study has been conducted so far to compare the efficiencies of prednisolone, alendronate, and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. We aimed to perform a multicenter, retrospective study assessing clinical characteristics and treatment results. Methods:A standard questionnaire was uploaded to an online national database system to collect data of children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication (serum 25-hydroxyvitamin D level >150 ng/mL) who were treated in pediatric endocrinology clinics.Results: Seventy-four children [median age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. Highdose vitamin D intake was obvious in 77% of the cases. At diagnosis, serum calcium, phosphorus, ALP, 25-hydroxyvitamin D, and PTH levels were 15±3.2 mg/dl, 5.2±1.2 mg/dL, 268±132 IU/L, 322 (236-454) ng/mL, and 5.5 (3-10.5) pg/mL, respectively. Calcium levels showed only weak correlation with 25-hydroxyvitamin D levels (rs=0.402, p<0.001). Patients were designated into five groups according to the initial specific treatment regimens (hydration-only, prednisolone, alendronate, pamidronate, and combination). Need for another type of specific drug treatment was higher in children who initially received prednisolone (p<0.001). Recurrence rate of hypercalcemia was significantly lower in children who were treated with pamidronate (p=0.02). u n c o r r e c t e d p r o o f 3 Conclusion: In mild cases, prednisolone or bisphosphonate treatments are not needed. Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens would be considered.

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Efficacy and safety of pamidronate in children with vitamin D intoxication

Cited by 13 publications

References 37 publications

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia

Comparison of Treatment Regimens for the Management of Severe Hypercalcemia due to Vitamin D Intoxication in Children

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