title: Hypercalcemia and human nature.
abstract: Patients on hemodialysis may develop severe and symptomatic hypercalcemia if skeletal buffering is ineffective. We report a case of persistent hypercalcemia with apparent extrarenal vitamin D synthesis. Associated aluminium intoxication was suggested on desferrioxamine challenge and adynamic uremic osteodystrophy confirmed on bone biopsy. Plasma calcitriol did not suppress with corticosteroids but did with ketoconazole. No other evidence for underlying granulomatous disease was found. We discuss our approach to less usual causes of hypercalcemia, and emphasise the pitfalls associated with factitious disorders.
authors.affiliation: Department of Renal Medicine and Transplantation, Royal London and St. Bartholomew's Hospitals, Whitechapel, UK. N.Ashman@mds.qmw.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Ashman
authors.forename: H H
authors.initials: HH
authors.lastname: Malluche
authors.forename: J
authors.initials: J
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000535:Aluminum / Q000506:poisoning; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D005162:Factitious Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000009:adverse effects*; D006934:Hypercalcemia / Q000097:blood / Q000139:chemically induced*; D006435:Renal Dialysis; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D006887:Hydroxycholecalciferols; D000535:Aluminum; D002117:Calcitriol; D002118:Calcium; C008088:alfacalcidol