Pamidronate: Treatment for severe hypercalcemia in neonatal subcutaneous fat necrosis.
BACKGROUND
Subcutaneous fat necrosis (SCFN) of the newborn is an uncommon disorder that occurs in the first weeks of life after foetal distress. It can be complicated by potentially life-threatening hypercalcemia. Treatments of hypercalcemia have included hydration, furosemide and corticosteroids. Only one report has described the use of intravenous bisphosphonates for this condition. We propose that pamidronate could be the first line therapy for severe hypercalcemia in SCFN.


RESULTS
Four newborns presented between 2001 and 2004 with SCFN complicated by severe hypercalcemia. At diagnosis, ionized calcium levels were higher than 1.4 mmol/l and were associated with high urinary calcium/creatinine ratios and high 1,25-dihydroxyvitamin D levels. Despite treatment with IV fluids, low calcium diet and furosemide, calcium levels remained high. The patients were given 3-4 doses (0.25-0.50 mg/kg/dose) of pamidronate. Urinary calcium/creatinine ratios and calcium levels decreased within 48-96 h. 1,25-dihydroxyvitamin D levels normalized with resolution of the skin lesions. No persistent nephrocalcinosis was observed.


CONCLUSIONS
Pamidronate is effective, well-tolerated in the short-term and obviates the need for prolonged treatment with furosemide and corticosteroids. To prevent nephrocalcinosis, pamidronate might be considered as first line treatment for severe hypercalcemia in SCFN.
Alos
Nathalie
N
Endocrinology Service, Sainte-Justine Hospital and Research Center, Université de Montréal, Montréal, Québec, Canada. nathalie.alos@recherche-ste-justine.qc.ca
Eugène
Dardye
D
Fillion
Marc
M
Powell
Julie
J
Kokta
Victor
V
Chabot
Gilles
G
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000378:metabolism; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D005218:Fat Necrosis / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D008297:Male; D000077268:Pamidronate; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000473:pathology
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate; D002118:Calcium