title: Reversible vascular calcifications associated with hypervitaminosis D.
abstract: A 64-year-old man was hospitalized in 2002 with symptoms of stupor, weakness, and renal colic. The clinical examination indicated borderline hypertension, small masses in the glutei, and polyuria. Laboratory tests evidenced high serum concentrations of creatinine, calcium, and phosphate. Imaging assessments disclosed widespread vascular calcifications, gluteal calcifications, and pelvic ectasia. Subsequent lab tests indicated suppressed serum parathyroid hormone, extremely high serum 25-hydroxy vitamin D, and normal serum 1,25-dihydroxy vitamin D. Treatment was started with intravenous infusion of saline and furosemide due to the evidence of hypercalcemia. Prednisone and omeprazole were added given the evidence of hypervitaminosis D. The treatment improved serum calcium, kidney function, and consciousness. The medical history disclosed recent treatment with exceptionally high doses of slow-release intra-muscular cholecalciferol and the recent excretion of urinary stones. The patient was discharged when it was possible to stop the intravenous treatment. The post-discharge treatment included oral hydration, furosemide, prednisone and omeprazole for approximately 6 months up to complete resolution of the hypercalcemia. The patient came back 12 years later because of microhematuria. Lab tests were normal for calcium/phosphorus homeostasis and kidney function. Imaging tests indicated only minor vascular calcifications. This is the first evidence of reversible vascular calcifications secondary to hypervitaminosis D.
authors: Department of Medicine and Surgery, University of Salerno, Campus of Medicine, via Salvador Allende, 43, 84081, Baronissi (SA), Italy. mcirillo@unisa.it.
authors: Massimo
authors: M
authors: Cirillo
authors: Department of Medicine and Surgery, University of Salerno, Campus of Medicine, via Salvador Allende, 43, 84081, Baronissi (SA), Italy.
authors: Giancarlo
authors: G
authors: Bilancio
authors: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
authors: Chiara
authors: C
authors: Cirillo
mesh_terms: D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002762:Cholecalciferol / Q000008:administration & dosage / Q000009:adverse effects*; D004232:Diuretics / Q000008:administration & dosage; D005440:Fluid Therapy / Q000379:methods; D005665:Furosemide / Q000008:administration & dosage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D009853:Omeprazole / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012074:Remission Induction; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D061205:Vascular Calcification / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D015415:Biomarkers; D004232:Diuretics; D005938:Glucocorticoids; D054328:Proton Pump Inhibitors; D014807:Vitamin D; D002762:Cholecalciferol; D012965:Sodium Chloride; C097949:1,25-dihydroxyvitamin D; D005665:Furosemide; C104450:25-hydroxyvitamin D; D009853:Omeprazole; D002118:Calcium; D011241:Prednisone
keywords: Cholecalciferol; Hypercalcemia; Vascular calcification; Vitamin D