BISPHOSPHONATES FOR THE TREATMENT OF CALCITRIOL-INDUCED HYPERCALCEMIA
Identifieur interne : 000269 ( Pmc/Curation ); précédent : 000268; suivant : 000270BISPHOSPHONATES FOR THE TREATMENT OF CALCITRIOL-INDUCED HYPERCALCEMIA
Auteurs : Roselyn Cristelle Isidro Mateo ; Ricardo Ortiz ; Harold Noah RosenSource :
- AACE Clinical Case Reports [ 2376-0605 ] ; 2019.
Abstract
Calcitriol excess is a less common cause of hypercalcemia than hyperparathyroidism. Hypercalcemia due to calcitriol excess is usually managed acutely with intravenous (IV) fluid administration and dietary calcium restriction. Steroids and ketoconazole are second-line agents. There is evidence supporting the role of bone resorption in the genesis of hypercalcemia in vitamin D intoxication and for a rapid response of hypercalcemia to treatment with bisphosphonates. We seek to demonstrate the utility of bisphosphonates in calcitriol-induced hypercalcemia (CIH).
We present the case of a patient with recurrent CIH from a follicular lymphoma who achieved normalization and subsequent stabilization of serum calcium levels following bisphosphonate administration
A 77-year-old woman with a history of non-small cell lung cancer was admitted with dry mouth, polyuria, weight loss, and fatigue. She was found to have a calcium level of 14.7 mg/dL (normal range is 8.5 to 10.2 mg/dL), 25-hydroxyvitamin D of 47 ng/mL (normal range is 30 to 60 ng/mL), 1,25-dihydroxyvitamin D of 89 pg/mL (normal range is 18 to 72 pg/mL), and parathyroid hormone of 19 pg/mL (normal range is 15 to 65 pg/mL), which recurred despite treatment with IV fluids and strict low-calcium diet. She received 5 mg of IV zoledronic acid and normocalcemia was maintained thereafter, without any diagnosis-specific treatment for >3 months. Positron emission tomography with computed tomography eventually showed new innumerable foci of increased uptake in the skeleton and lymph node biopsy revealed grade 3A follicular lymphoma.
The first choice for CIH is treating the underlying cause. Bisphosphonates are, however, useful until a diagnosis is made, as they may be safer than steroids and can provide rapid relief even with a single treatment with minimal side effects.
Url:
DOI: 10.4158/ACCR-2019-0101
PubMed: 31967061
PubMed Central: 6876953
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<author><name sortKey="Mateo, Roselyn Cristelle Isidro" sort="Mateo, Roselyn Cristelle Isidro" uniqKey="Mateo R" first="Roselyn Cristelle Isidro" last="Mateo">Roselyn Cristelle Isidro Mateo</name>
</author>
<author><name sortKey="Ortiz, Ricardo" sort="Ortiz, Ricardo" uniqKey="Ortiz R" first="Ricardo" last="Ortiz">Ricardo Ortiz</name>
</author>
<author><name sortKey="Rosen, Harold Noah" sort="Rosen, Harold Noah" uniqKey="Rosen H" first="Harold Noah" last="Rosen">Harold Noah Rosen</name>
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<series><title level="j">AACE Clinical Case Reports</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective:</title>
<p>Calcitriol excess is a less common cause of hypercalcemia than hyperparathyroidism. Hypercalcemia due to calcitriol excess is usually managed acutely with intravenous (IV) fluid administration and dietary calcium restriction. Steroids and ketoconazole are second-line agents. There is evidence supporting the role of bone resorption in the genesis of hypercalcemia in vitamin D intoxication and for a rapid response of hypercalcemia to treatment with bisphosphonates. We seek to demonstrate the utility of bisphosphonates in calcitriol-induced hypercalcemia (CIH).</p>
</sec>
<sec><title>Methods:</title>
<p>We present the case of a patient with recurrent CIH from a follicular lymphoma who achieved normalization and subsequent stabilization of serum calcium levels following bisphosphonate administration</p>
</sec>
<sec><title>Results:</title>
<p>A 77-year-old woman with a history of non-small cell lung cancer was admitted with dry mouth, polyuria, weight loss, and fatigue. She was found to have a calcium level of 14.7 mg/dL (normal range is 8.5 to 10.2 mg/dL), 25-hydroxyvitamin D of 47 ng/mL (normal range is 30 to 60 ng/mL), 1,25-dihydroxyvitamin D of 89 pg/mL (normal range is 18 to 72 pg/mL), and parathyroid hormone of 19 pg/mL (normal range is 15 to 65 pg/mL), which recurred despite treatment with IV fluids and strict low-calcium diet. She received 5 mg of IV zoledronic acid and normocalcemia was maintained thereafter, without any diagnosis-specific treatment for >3 months. Positron emission tomography with computed tomography eventually showed new innumerable foci of increased uptake in the skeleton and lymph node biopsy revealed grade 3A follicular lymphoma.</p>
</sec>
<sec><title>Conclusion:</title>
<p>The first choice for CIH is treating the underlying cause. Bisphosphonates are, however, useful until a diagnosis is made, as they may be safer than steroids and can provide rapid relief even with a single treatment with minimal side effects.</p>
</sec>
</div>
</front>
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<pmc article-type="case-report"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">AACE Clin Case Rep</journal-id>
<journal-id journal-id-type="iso-abbrev">AACE Clin Case Rep</journal-id>
<journal-id journal-id-type="publisher-id">cecr</journal-id>
<journal-id journal-id-type="pmc">AACE Clin Case Rep</journal-id>
<journal-title-group><journal-title>AACE Clinical Case Reports</journal-title>
</journal-title-group>
<issn pub-type="epub">2376-0605</issn>
<publisher><publisher-name>American Association of Clinical Endocrinologists</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">31967061</article-id>
<article-id pub-id-type="pmc">6876953</article-id>
<article-id pub-id-type="doi">10.4158/ACCR-2019-0101</article-id>
<article-id pub-id-type="sici">i2376-0605-5-5-e316</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Reports</subject>
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<title-group><article-title>BISPHOSPHONATES FOR THE TREATMENT OF CALCITRIOL-INDUCED HYPERCALCEMIA</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Mateo</surname>
<given-names>Roselyn Cristelle Isidro</given-names>
</name>
<degrees>MD, MS</degrees>
<xref ref-type="author-notes" rid="fn1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ortiz</surname>
<given-names>Ricardo</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="author-notes" rid="fn1"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Rosen</surname>
<given-names>Harold Noah</given-names>
</name>
<degrees>MD, CCD</degrees>
<xref ref-type="author-notes" rid="fn1"></xref>
</contrib>
</contrib-group>
<author-notes><fn id="fn1"><p>From the Department of Medicine, Division of Endocrinology and Metabolism, Beth Israel Deaconess Medical Center, Boston, Massachusetts.</p>
</fn>
<corresp id="cor1">Address correspondence to Dr. Harold Rosen, Division of Endocrinology, GZ-6, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. E-mail: <email>hrosen@bidmc.harvard.edu</email>
.</corresp>
<fn fn-type="COI-statement"><p><bold>DISCLOSURE</bold>
</p>
<p>The authors have no multiplicity of interest to disclose.</p>
</fn>
</author-notes>
<pub-date pub-type="collection"><season>Sep-Oct</season>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub"><day>26</day>
<month>6</month>
<year>2019</year>
</pub-date>
<volume>5</volume>
<issue>5</issue>
<fpage>e316</fpage>
<lpage>e320</lpage>
<history><date date-type="received"><day>22</day>
<month>2</month>
<year>2019</year>
</date>
<date date-type="accepted"><day>10</day>
<month>6</month>
<year>2019</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2019 AACE.</copyright-statement>
<copyright-year>2019</copyright-year>
</permissions>
<abstract><sec><title>Objective:</title>
<p>Calcitriol excess is a less common cause of hypercalcemia than hyperparathyroidism. Hypercalcemia due to calcitriol excess is usually managed acutely with intravenous (IV) fluid administration and dietary calcium restriction. Steroids and ketoconazole are second-line agents. There is evidence supporting the role of bone resorption in the genesis of hypercalcemia in vitamin D intoxication and for a rapid response of hypercalcemia to treatment with bisphosphonates. We seek to demonstrate the utility of bisphosphonates in calcitriol-induced hypercalcemia (CIH).</p>
</sec>
<sec><title>Methods:</title>
<p>We present the case of a patient with recurrent CIH from a follicular lymphoma who achieved normalization and subsequent stabilization of serum calcium levels following bisphosphonate administration</p>
</sec>
<sec><title>Results:</title>
<p>A 77-year-old woman with a history of non-small cell lung cancer was admitted with dry mouth, polyuria, weight loss, and fatigue. She was found to have a calcium level of 14.7 mg/dL (normal range is 8.5 to 10.2 mg/dL), 25-hydroxyvitamin D of 47 ng/mL (normal range is 30 to 60 ng/mL), 1,25-dihydroxyvitamin D of 89 pg/mL (normal range is 18 to 72 pg/mL), and parathyroid hormone of 19 pg/mL (normal range is 15 to 65 pg/mL), which recurred despite treatment with IV fluids and strict low-calcium diet. She received 5 mg of IV zoledronic acid and normocalcemia was maintained thereafter, without any diagnosis-specific treatment for >3 months. Positron emission tomography with computed tomography eventually showed new innumerable foci of increased uptake in the skeleton and lymph node biopsy revealed grade 3A follicular lymphoma.</p>
</sec>
<sec><title>Conclusion:</title>
<p>The first choice for CIH is treating the underlying cause. Bisphosphonates are, however, useful until a diagnosis is made, as they may be safer than steroids and can provide rapid relief even with a single treatment with minimal side effects.</p>
</sec>
</abstract>
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</front>
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