Ketoconazole decreases the serum ionized calcium and 1,25-dihydroxyvitamin D levels in tuberculosis-associated hypercalcemia.
OBJECTIVE
To evaluate whether tuberculosis-associated hypercalcemia is related to abnormal synthesis of 1,25-dihydroxyvitamin D (1,25[OH]2D) and whether ketoconazole administration may be useful in treating tuberculosis-associated hypercalcemia.


METHODS
Case study.


METHODS
Endocrine Unit, Pediatric Clinic, University of Pisa (Italy).


METHODS
Two boys (aged 10.5 years and 14.7 years) with active tuberculosis and hypercalcemia.


RESULTS
At admission, serum 1,25-dihydroxyvitamin D levels were elevated. Oral ketoconazole administration (3.0 mg/kg every 8 hours) decreased 1,25-dihydroxyvitamin D levels within the first week of therapy (from 208.8 to 57.6 pmol/L [-72.4%] in one boy and from 321.6 to 115.2 pmol/L [-64.2%] in the other). We also found a coincident normalization of serum ionized calcium concentration (from 1.45 to 1.24 mmol/L [-13.0%] in one boy and from 1.55 to 1.26 mmol/L [-17.0%] in the other).


CONCLUSIONS
Abnormal elevated levels of 1,25-dihydroxyvitamin D caused hypercalcemia in our patients; ketoconazole administration may be effective in the treatment of hypercalcemia in patients with tuberculosis, which decreases 1,25-dihydroxyvitamin D synthesis.
Saggese
G
G
Department of Pediatrics, University of Pisa, Italy.
Bertelloni
S
S
Baroncelli
G I
GI
Di Nero
G
G
D015652:25-Hydroxyvitamin D 2 / Q000097:blood*; D000293:Adolescent; D002117:Calcitriol / Q000097:blood*; D002118:Calcium / Q000097:blood*; D002648:Child; D003404:Creatinine / Q000097:blood / Q000652:urine; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006934:Hypercalcemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007654:Ketoconazole / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011859:Radiography; D013960:Thyroid Function Tests; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology
D010281:Parathyroid Hormone; D015652:25-Hydroxyvitamin D 2; D010758:Phosphorus; D003404:Creatinine; D002117:Calcitriol; D007654:Ketoconazole; D002118:Calcium; D006854:Hydrocortisone