Hypercalcemia Associated with Silicone-Induced Granulomas

Kozeny, Gregory A.; Barbato, Anthony L.; Bansal, Vinod; Vertuno, Leonard L.; Hano, Jessie E.

doi:10.1056/nejm198410253111707

Cited by 140 publications

(49 citation statements)

References 13 publications

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“…Sometimes granulomas can be removed by the local intra lesional injection of corticoids (14). There exist reports in the literature of granulomatous reactions produced by silicones associated with hypercalcemia (8,(15)(16)(17) but as far as we know there are no registered cases of hypercalcemia induced by granulomas produced by methacrylate injection. In this case series we report four young women that underwent methacrylate injections in gluteus, thighs and calves that developed granulomas with posterior appearance of hypercalcemia.…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia secondary to granulomatous disease caused by the injection of methacrylate: a case series

et al. 2014

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SummaryAssociation of dysregulated calcium homeostasis and granulomatous disease is well established. There exist reports in the literature of granulomatous reactions produced by silicones associated with hypercalcemia. In this case series we report four young women that underwent methacrylate injections in gluteus, thighs and calves that developed granulomas with posterior appearance of hypercalcemia. This complication presented as subacute around 6 months after the procedure. The four patients have as common elements the presence of moderate to severe renal insufficiency, suppressed PTH and elevated calcitriol levels for the degree of renal function. In the image studies, two patients presented in the nuclear magnetic resonance of the gluteus hypodense nodular images compatible with granulomas. Two patients had a positron emission tomography performed showing increased metabolic activity in the muscles of the gluteal region compatible with granulomas. Two patients had a partial surgical resection of the gluteal lesions with the finding of methacrylate associated to foreign body granulomas. In these patients hypercalcemia was treated with oral or local injections of corticoids, intravenous bisphosphonates or ketoconazole with good response. Although the prevalence of this complication with methacrylate injection is not common, hypercalcemia secondary to granulomas should be considered in the differential diagnosis of patients with hypercalcemia when there is a history of this procedure, and especially if they have a reduction in their renal function.

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Section: Discussionmentioning

confidence: 99%

Hypercalcemia secondary to granulomatous disease caused by the injection of methacrylate: a case series

et al. 2014

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“…The earliest were berylliosis and tuberculosis [6,16]. Then hypercalcemia was found in patients with histoplas mosis [17], eosinophilic granulomas [18], and coccidio idomycosis [19], The most recent granulomatous disease associated with hypercalcemia is silicone-induced granu lomas [20], In all of these other granulomatous diseases a similar mechanism of hypercalcemia to that of sarcoido sis has been suggested. Earlier studies in these conditions demonstrate a similar metabolic profile during hyercalcemia to that of sarcoidosis by showing hypercalcemia, hypercalciuria, suppressed levels of parathyroid hor mone, and response of hypercalcemia to corticosteroid therapy.…”

Section: Dr Zawada I Will Now Discuss the Hypercalcemia And The Renamentioning

confidence: 99%

“…Earlier studies in these conditions demonstrate a similar metabolic profile during hyercalcemia to that of sarcoidosis by showing hypercalcemia, hypercalciuria, suppressed levels of parathyroid hor mone, and response of hypercalcemia to corticosteroid therapy. Later studies measured 1,25-dihydroxyvitamin D levels in sarcoidosis and silicone granulomas and found them to be elevated, to rise in response to oral vitamin D supplementation, and to fall during remission of disease with corticosteroid theraphy [15,20]. The dif ferentiation of sarcoidosis from other granulomatous dis eases is often difficult and is aided in part by the finding of normal angiotensin-converting enzyme levels [17], Most often in these cases of granulomatous hypercal cemia, the lung is the granulomatous tissue thought to be synthesizing the 1,25-dihydroxyvitamin D3.…”

Section: Dr Zawada I Will Now Discuss the Hypercalcemia And The Renamentioning

confidence: 99%

Hypercalcemia and Acute Renal Insufficiency in a 24-Year-Old White Male with Lung Disease

et al. 1986

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“…The mass spectrum of the putative 1,25(OH)2D produced by sarcoid tissue in vitro was confirmed (44). Hypercalcemia associated with abnormal elevation of serum 1,25(OH)2D was described in tuberculosis (45,46), lymphoma (47,48), disseminated candidiasis (49), and silicon-induced granuloma (50). Modest impairment in the regulation of circulating 1,25(OH)2D in response to vitamin D challenge is present in patients with active pulmonary tuberculosis and normal calcium metabolism (45).…”

Section: Regulation Of Vitamin D Metabolismmentioning

confidence: 99%