Case Report: Hypercalcemia With Inappropriate 1,25-Dihydroxyvitamin D in Wegener’s Granulomatosis

Extrarenal 1α-Hydroxylase

“…Silicone-induced granulomatosis [60] Langerhans cell histiocyosis [61,63] Wegener's granulomatosis [62,277,278] Berylliosis [279] Lipoid pneumonia [280,281] Talc granulomatosis [282] Infantile fat necrosis [66] Slack skin disease [283] Giant cell polymyositis [35] Crohn Plasma cell granuloma [284] Dysgerminoma [151,285] Seminoma [286] [1e5,13e17,19,39e41]. In the most expansive studies published on the topic, roughly 10% of patients with sarcoidosis develop hypercalcemia [41], and up to 50% suffer from hypercalciuria [41] at some time during the course of their disease.…”

Silicone‐induced granulomas and renal failure

“…Low‐dose glucocor‐ticoids (10–30 mg of prednisone per day) have been used in patients with sarcoid‐osis. It is thought that steroids decrease the activity of activated mononuclear cells that produce 1,25‐dihydroxyvitamin D31 lomatosis 25. This patient had a serum 1,25dihydroxyvitamin D level of 38 pg/mL, which was inappropriately elevated in the setting of renal insuffi ciency, suppressed PTH, hyperphosphatemia, and hypercalcemia 25.…”

“…It is thought that steroids decrease the activity of activated mononuclear cells that produce 1,25‐dihydroxyvitamin D31 lomatosis 25. This patient had a serum 1,25dihydroxyvitamin D level of 38 pg/mL, which was inappropriately elevated in the setting of renal insuffi ciency, suppressed PTH, hyperphosphatemia, and hypercalcemia 25. There are other reported cases of patients with hypercalcemia due to extra‐renal production of 1,25‐dihydroxyvitamin D where serum levels are within the upper‐normal range, and yet, still considered inappropriately elevated 26‐29.…”

Hypercalcemia Associated with Wegener’s Granulomatosis and Hyperparathyroidism: Etiology and Management

“…We are not aware of previous cases in which Wegener's granulomatosis specifically has been reported to cause hypercalcemia nor of cases in which it coexists with hyperparathyroidism. However, subse quently Shaker et al reported a case of hypercalcemia with inappropriate 1,25-dihydroxy vitamin D in Wege ner's granulomatosis [7], In hypercalcemia secondary to granulomatous disease, intact PTH levels are typically normal or reduced [8]. In our patient, a diagnosis of both hyperparathyroidism and excess calcitriol due to granulomatous disease was made based upon the inappropriately elevated (nonsuppressed) intact PTH level in the face of hypercalcemia, together with elevated 1,25-dihydroxyvitamin D levels in the face of renal failure, and unresponsiveness of hypercalcemia to steroid therapy.…”