Vitamin D poisoning with metastatic calcification

Wilson, C. W.; Wingfield, William L.; Toone, Elam C.

doi:10.1016/0002-9343(53)90363-5

Cited by 21 publications

(4 citation statements)

References 13 publications

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“…Metastatic pulmonary calcification is further subdivided into benign (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and malignant causes (16)(17)(18)(19)(20)(21) (Table 1). By far the most common cause of metastatic calcification is seen in patients on hemodialysis for chronic renal insufficiency.…”

Section: Clinical Classification Of Pulmonary Calcification and Ossifmentioning

confidence: 99%

Calcium Deposition with or without Bone Formation in the Lung

Chan

Morales

Welsh

et al. 2002

Am J Respir Crit Care Med

328

370

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Pulmonary calcification and ossification occurs with a number of systemic and pulmonary conditions. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. Pathophysiologic states predisposing to pulmonary calcification and ossification include hypercalcemia, a local alkaline environment, and previous lung injury. Factors such as enhanced alkaline phosphatase activity, active angiogenesis, and mitogenic effects of growth factors may also contribute. The clinical classification of pulmonary calcification includes both metastatic calcification, in which calcium deposits in previously normal lung or dystrophic calcification, which occurs in previously injured lung. Pulmonary ossification can be idiopathic or can result from a variety of underlying pulmonary, cardiac, or extracardiopulmonary disorders. The diagnosis of pulmonary calcification and ossification requires various imaging techniques, including chest radiography, computed tomographic scanning, and bone scintigraphy. Interpretation of the presence of and the specific pattern of calcification or ossification may obviate the need for invasive biopsy. In this review, specific conditions causing pulmonary calcification or ossification that may impact diagnostic and treatment decisions are highlighted. These include metastatic calcification caused by chronic renal failure and orthotopic liver transplantation, dystrophic calcification caused by granulomatous disorders, DNA viruses, parasitic infections, pulmonary amyloidosis, vascular calcification, the idiopathic disorder pulmonary alveolar microlithiasis, and various forms of pulmonary ossification.

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Section: Clinical Classification Of Pulmonary Calcification and Ossifmentioning

confidence: 99%

Calcium Deposition with or without Bone Formation in the Lung

Chan

Morales

Welsh

et al. 2002

Am J Respir Crit Care Med

328

370

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“…1,8 Most of the other benign causes are related to calcium balance. 6,16 In addition, utilization of vitamin D in dialysis patients may be associated with or may trigger metastatic calcification. 1,8 Metastatic pulmonary calcification or visceral calcification was previously shown to be primarily amorphous whitlockite in composition, rather than the crystalline hydroxyapatite more commonly found in vascular calcification.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Utilizing vitamin D may contribute, as hypervitaminosis D has been associated with metastatic and vascular calcification. 6,16 In addition, utilization of vitamin D in dialysis patients may be associated with or may trigger metastatic calcification. 17 It has been suggested that tissues are sensitized by the above factors, and may require some additional stress to calcify.…”

Section: Discussionmentioning

confidence: 99%

Metastatic pulmonary calcification in a dialysis patient: Case report and a review

Eggert

Albright

2006

Hemodialysis International

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A 19-year-old male presented with chest pain and dyspnea. He was anephric following nephrectomy for focal segmental glomerulosclerosis, had a subsequent failed transplant, and had been dialysis dependent for 3 years. Workup revealed hyperparathyroidism and an abnormal chest X-ray and computed tomography scan, significant for massive extra-skeletal pulmonary calcification. A markedly abnormal Technitium99 methylene diphosphonate (Tc99m-MDP) bone scan confirmed the clinical suspicion of metastatic pulmonary calcification. Metastatic pulmonary calcification (MPC) is common, occurring in 60% to 80% of dialysis patients on autopsy and bone scan series. It may lead to impaired oxygenation and restrictive lung disease. Typically, the calcium crystal is whitlockite rather than hydroxyapatite, which occurs in vascular calcification. Four major predisposing factors may contribute to MPC in dialysis patients. First, chronic acidosis leaches calcium from bone. Second, intermittent alkalosis favors deposition of calcium salts. Third, hyperparathyroidism tends to cause bone resorption and intracellular hypercalcemia. Finally, low glomerular filtration rate can cause hyperphosphatemia and an elevated calcium-phosphorus product. There may be other factors. Some authors suggest that the incidence of MPC in recent years may be lower due to improved dialysis techniques. The diagnosis is confirmed by biopsy, but can be suspected by typical findings on a Tc99m-MDP bone scan. Therapy is limited to ensuring adequate dialysis, correcting calcium-phosphorus product, and hyperparathyroidism; discontinuing vitamin D analogues may help. Conflicting reports show that transplantation may either improve or worsen the situation. MPC should be considered in dialysis patients who have characteristic abnormal chest radiography and/or pulmonary symptoms.

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“…The lesions regress as calcium and phosphate serum levels normalize. 1 It can be observed in hypercalcemia associated with primary or secondary hyperparathyroidism, destructive lesions of bone, hypervitaminosis D, 30 and milk alkali syndrome, 31 which is characterized by excessive ingestion of food or antacids containing calcium and other rare causes. In addition, skin calcification has been reported in sarcoidosis, 32 pseudohyperparathyroidism, 33 neoplasms associated with bony destruction, and after liver and lung transplants because of the large amounts of intravenous calcium needed to correct hypocalcemia after the use of blood products.…”

Section: Metastatic Calcificationmentioning

confidence: 99%

Cutaneous Deposits

Molina-Ruiz

Cerroni

Kutzner

et al. 2014

The American Journal of Dermatopathology

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: The cutaneous deposition disorders are a group of unrelated conditions characterized by the accumulation of either endogenous or exogenous substances within the skin. These cutaneous deposits are substances that are not normal constituents of the skin and are laid down usually in the dermis, but also in the subcutis, in a variety of different circumstances. There are 5 broad categories of cutaneous deposits. The first group includes calcium salts, bone, and cartilage. The second category includes the hyaline deposits that may be seen in the dermis in several metabolic disorders, such as amyloidosis, gout, porphyria, and lipoid proteinosis. The third category includes various pigments, heavy metals, and complex drug pigments. The fourth category, cutaneous implants, includes substances that are inserted into the skin for cosmetic purposes. The fifth category includes miscellaneous substances, such as oxalate crystals and fiberglass. In this article, the authors review the clinicopathologic characteristics of cutaneous deposition diseases, classify the different types of cutaneous deposits, and identify all the histopathologic features that may assist in diagnosing the origin of a cutaneous deposit.

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Vitamin D poisoning with metastatic calcification

Cited by 21 publications

References 13 publications

Calcium Deposition with or without Bone Formation in the Lung

Calcium Deposition with or without Bone Formation in the Lung

Metastatic pulmonary calcification in a dialysis patient: Case report and a review

Cutaneous Deposits

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