Rare Causes of Hypercalcemia

Jacobs, Thomas P.; Bilezikian, John P.

doi:10.1210/jc.2005-0675

Cited by 208 publications

(124 citation statements)

References 83 publications

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“…The most widely known granulomatous diseases causing hypercalcemia are tuberculosis, sarcoidosis, and systemic fungal infections. Hypercalcemia in these situations is mostly attributed to increase in serum calcitriol levels, due to higher 1alfa-hydroxylase activity in activated macrophages (1,2), although, in some patients, hypercalcemia has been associated with PTHrp (3,4). In several patients with granulomatous diseases and hypercalcemia, serum calcitriol levels have been in the normal range, which are inappropriately high, considering the low serum PTH levels (2).…”

Section: Discussionmentioning

confidence: 99%

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review

Rados

Furlanetto

2015

Arch. Endocrinol. Metab.

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SUMMARYHypercalcemia is a common condition in the internal medicine practice. Sometimes its cause is not readily apparent, so extensive investigation is appropriate. Here we report an unexpected cause for hypercalcemia in an elderly woman. The case of an 82-years old woman with PTH-independent hypercalcemia, lymphocytosis, normal serum 1,25 (OH)vitamin D levels, and low serum PTHrp levels, is described. Medical history and complementary investigation were unremarkable, except for increased metabolic activity in the glutei regions, as measured by whole body 18F-FDG PET-CT. Reviewing her medical history, her sister recalled that she had been submitted to intramuscular methylmethacrylate injections, for cosmetic purposes, five years before presentation, which was confirmed by muscle biopsy. Low calcium intake, parenteral bisphosphonates, calcitonin, and glucocorticoids were used to control serum calcium levels. Methylmethacrylate injections, used cosmetically, are a new cause for hypercalcemia, even after many years. Hypercalcemia was probably due to calcitriol overproduction in foreign body granulomas. Persistent reactive lymphocytosis could be a clue for this inflammatory cause of hypercalcemia. Arch Endocrinol Metab. 2015;59(3):277-80

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Section: Discussionmentioning

confidence: 99%

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review

Rados

Furlanetto

2015

Arch. Endocrinol. Metab.

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“…In the presence of hypercalcemia neuromuscular symptoms such as changes in consciousness, muscle weakness and fatigue may occur as well as gastrointestinal and cardiac symptoms. Tuberculosis is one of the rare reasons of hypercalcemia (2). Incidence of the hypercalcemia due to tuberculosis varies depending on regional sunlight exposure, vitamin D and calcium intake (3).…”

Section: Discussionmentioning

confidence: 99%

A Case of Tuberculosis Presented with Syncope and Hypercalcemia

Ayçiçek¹

2017

IJCC

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“…To our knowledge, very few reports have described an association between hypercalcemia and MODS. (7,8) Of the 415 patients with MODS, 18 received LLT, and 11 of these patients presented with hypercalcemia. The other 12 patients with hypercalcemic MODS were not recipients of liver transplantation but did present with severe liver injury and marked jaundice (Table 1).…”

Section: Discussionmentioning

confidence: 99%

A patient with severe hypercalcemia in multiple organ dysfunction syndrome: Role of elevated circulating 1α,25(OH)2vitamin D levels

Kazama

Yamamoto

Oya

et al. 2010

Journal of Bone and Mineral Research

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A 54-year-old man was transferred to our ICU because of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). He died after 38 days of intensive care. During treatment, his serum calcium (Ca) levels continued to increase and reached 3.95 mmol/L, while the ionized Ca levels reached 2.30 mmol/L before his death. He presented with severe kidney injury, pancreatitis, and hemorrhagic gastric erosion that worsened his prognosis; these were possibly associated with the hypercalcemia. His circulating 1a,25-dihydroxyvitamin D [1,25(OH) 2 D] level was elevated (75.7 to 204 pg/mL), whereas the levels of 25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone-related peptide were not. Liver histology revealed immunoreactivity for 25-hydroxyvitamin D 1a-hydroxylase (CYP27B1) in some of the hepatocytes, in which the localization pattern was similar to that of lysozyme-positive hepatocytes. Our ICU has previously encountered 22 similar MODS patients who presented with hypercalcemia over the last 8 years. SIRS with severe kidney and liver injuries are common clinical findings in hypercalcemic patients with MODS. Of the 23 hypercalcemic MODS patients, including the present patient, 17 had circulating 1,25(OH) 2 D levels exceeding 70 pg/mL despite severe kidney injury. Extrarenal activation of CYP27B1 seems to play a role in the development of hypercalcemia in this disease condition. Clinicians need to be aware that severe hypercalcemia may occur in MODS patients. ß

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Rare Causes of Hypercalcemia

Cited by 208 publications

References 83 publications

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review

An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review

A Case of Tuberculosis Presented with Syncope and Hypercalcemia

A patient with severe hypercalcemia in multiple organ dysfunction syndrome: Role of elevated circulating 1α,25(OH)2vitamin D levels

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