Calcitriol-mediated hypercalcemia: causes and course in 101 patients

Donovan, Peter J., Sundac, Lana, Pretorius, Carel J., d'Emden, Michael C. and McLeod, Donald S. A. (2013) Calcitriol-mediated hypercalcemia: causes and course in 101 patients. Journal of Clinical Endocrinology & Metabolism, 98 10: 4023-4029. doi:10.1210/jc.2013-2016


Author Donovan, Peter J.
Sundac, Lana
Pretorius, Carel J.
d'Emden, Michael C.
McLeod, Donald S. A.
Title Calcitriol-mediated hypercalcemia: causes and course in 101 patients
Journal name Journal of Clinical Endocrinology & Metabolism   Check publisher's open access policy
ISSN 0021-972X
1945-7197
Publication date 2013-10
Year available 2013
Sub-type Article (original research)
DOI 10.1210/jc.2013-2016
Open Access Status
Volume 98
Issue 10
Start page 4023
End page 4029
Total pages 7
Place of publication Chevy Chase, MD, United States
Publisher The Endocrine Society
Collection year 2014
Language eng
Formatted abstract
Context:
Hypercalcemia mediated by 1,25-dihydroxy vitamin D (calcitriol) is uncommon, with evidence on etiology limited to small case series or case reports.

Objective:
The objective of the study was to systematically identify a large series of cases of calcitriol-mediated hypercalcemia and document the presentation, demographics, and clinical course across etiologies.

Design, Setting, and Patients:

The study was a hospital-based, retrospective case series, identifying subjects from 1999 through 2009 across the public hospital system in Queensland, Australia. All patients aged over 18 years were identified that had persistent hypercalcemia associated with elevated or inappropriately normal calcitriol concentration or elevated serum angiotensin-converting enzyme.

Results:
A total of 101 cases were identified. Sarcoidosis was the most common etiology (49%), followed by hematological malignancy (17%) and infections (8%). Etiologies not previously described include squamous cell carcinoma of the tongue, ovarian cystadenocarcinoma, and chronic lymphocytic leukemia. Median serum angiotensin-converting enzyme was higher in sarcoid patients compared with all other causes [218 U/L (176–277) vs 155 U/L (110–208), P < .001], but a level above the normal range did not discriminate well between cases of sarcoidosis and other causes (specificity at cutoff of 130 U/L was only 31%). However, a value greater than 250 U/L was highly specific (89%) for sarcoidosis but lacked sensitivity (31%). A calcitriol level greater than 300 pmol/L was not seen in sarcoidosis but was seen with other etiologies. Cases with neoplastic etiologies were older (61.4 ± 11.4 y) than all other subjects (51.7 ± 15.0 y, P = .006).

Conclusions:
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.
Keyword Cultured Alveolar macrophages
Humoral hypercalcemia
Rare causes
Sarcoidosis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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