Case report: hypercalcemia with inappropriate 1,25-dihydroxyvitamin D in Wegener's granulomatosis.
Hypercalcemia associated with the extrarenal production of 1,25-dihydroxyvitamin D (1,25(OH)2D) has been reported in several disorders, most notably granulomatous diseases such as sarcoidosis. The authors describe a woman with hypercalcemia, renal insufficiency, microscopic hematuria, and anemia. The circulating 1,25(OH)2D level was higher than appropriate for the ambient conditions (renal insufficiency, suppressed intact parathyroid hormone, and hypercalcemia). A kidney biopsy was consistent with Wegener's granulomatosis, and treatment with prednisone and cyclophosphamide was associated with normalization of serum calcium levels, improved renal function, a marked decrease in serum 1,25(OH)2D levels, and increased serum intact parathyroid hormone levels. These findings are consistent with the unregulated production of 1,25(OH)2D by inflammatory cells associated with Wegener's granulomatosis.
Shaker
J L
JL
Department of Medicine, St. Luke's Medical Center, Milwaukee, Wisconsin 53215.
Redlin
K C
KC
Warren
G V
GV
Findling
J W
JW
D000368:Aged; D000740:Anemia / Q000209:etiology; D002117:Calcitriol / Q000097:blood*; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006417:Hematuria / Q000209:etiology; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011241:Prednisone / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000209:etiology; D012709:Serum Albumin / Q000032:analysis
D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; D003520:Cyclophosphamide; D003404:Creatinine; D002117:Calcitriol; D002118:Calcium; D011241:Prednisone