Hypercalcaemia Due to Isolated Elevation of 1,25-dihydroxyvitamin D in Patients with Crohn's Disease

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2019 Sep 28

PMID 31558487

Authors

Faisal Inayat

Saad Saleem

Adil Mohyudin

Zubair Khan

Affiliations

Soon will be listed here.

Abstract

Crohn's disease is frequently associated with hypocalcaemia following poor calcium intake and decreased intestinal calcium absorption due to malabsorption-related vitamin D deficiency. Severe hypercalcaemia found in Crohn's disease is an unusual clinical entity. We chronicle here the case of a patient who developed hypercalcaemia with elevated 1,25-dihydroxyvitamin D during Crohn's disease exacerbation. Furthermore, we conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding 1,25-dihydroxyvitamin D-associated hypercalcaemia in Crohn's disease. A comprehensive review of the search results yielded a total of five case reports only. The data on patient demographics, clinical features, serum calcium levels, Crohn's disease activity site, treatment strategy, hypercalcaemia resolution time and outcomes were collected and analysed. This paper illustrates that Crohn's disease should be added to the list of granulomatous disorders responsible for 1,25-dihydroxyvitamin D-mediated hypercalcaemia. Physicians should maintain a high index of clinical suspicion for this potential complication for prompt management.

References

Pouchot J, Dreyfuss D, Gardin J, Mier L, Remy P, Esdaile J . Ectopic production of 1,25-dihydroxyvitamin D3 in tuberculosis. Nephrol Dial Transplant. 1993; 8(6):560-2. DOI: 10.1093/ndt/8.6.560. View

Newman L, Rose C, Maier L . Sarcoidosis. N Engl J Med. 1997; 336(17):1224-34. DOI: 10.1056/NEJM199704243361706. View

DOnofrio G, Levitt S, Ilett K . Serum angiotensin converting enzyme in Crohn's disease, ulcerative colitis and peptic ulceration. Aust N Z J Med. 1984; 14(1):27-30. DOI: 10.1111/j.1445-5994.1984.tb03580.x. View

Insogna K, Dreyer B, Mitnick M, Ellison A, Broadus A . Enhanced production rate of 1,25-dihydroxyvitamin D in sarcoidosis. J Clin Endocrinol Metab. 1988; 66(1):72-5. DOI: 10.1210/jcem-66-1-72. View

Adams J . Vitamin D metabolite-mediated hypercalcemia. Endocrinol Metab Clin North Am. 1989; 18(3):765-78. View

Kogan B, Konnak J, Lau K . Marked hyperoxaluria in sarcoidosis during orthophosphate therapy. J Urol. 1982; 127(2):339-40. DOI: 10.1016/s0022-5347(17)53770-2. View

Dusso A, Kamimura S, Gallieni M, Zhong M, Negrea L, Shapiro S . gamma-Interferon-induced resistance to 1,25-(OH)2 D3 in human monocytes and macrophages: a mechanism for the hypercalcemia of various granulomatoses. J Clin Endocrinol Metab. 1997; 82(7):2222-32. DOI: 10.1210/jcem.82.7.4074. View

Doty J, Mazur J, Judson M . Treatment of sarcoidosis with infliximab. Chest. 2005; 127(3):1064-71. DOI: 10.1378/chest.127.3.1064. View

OLeary T, Jones G, Yip A, Lohnes D, Cohanim M, YENDT E . The effects of chloroquine on serum 1,25-dihydroxyvitamin D and calcium metabolism in sarcoidosis. N Engl J Med. 1986; 315(12):727-30. DOI: 10.1056/NEJM198609183151203. View

10.

Playford E, Bansal A, Looke D, Whitby M, Hogan P . Hypercalcaemia and elevated 1,25(OH)(2)D(3) levels associated with disseminated Mycobacterium avium infection in AIDS. J Infect. 2001; 42(2):157-8. DOI: 10.1053/jinf.2000.0767. View

11.

Silvennoinen J, Karttunen T, Niemela S, Manelius J, Lehtola J . A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut. 1995; 37(1):71-6. PMC: 1382771. DOI: 10.1136/gut.37.1.71. View

12.

Ioachimescu A, Bauer T, Licata A . Active crohn disease and hypercalcemia treated with infliximab: case report and literature review. Endocr Pract. 2008; 14(1):87-92. DOI: 10.4158/EP.14.1.87. View

13.

Studdy P, Bird R, James D . Serum angiotensin-converting enzyme (SACE) in sarcoidosis and other granulomatous disorders. Lancet. 1978; 2(8104-5):1331-4. DOI: 10.1016/s0140-6736(78)91972-4. View

14.

Bosch X . Hypercalcemia due to endogenous overproduction of 1,25-dihydroxyvitamin D in Crohn's disease. Gastroenterology. 1998; 114(5):1061-5. DOI: 10.1016/s0016-5085(98)70327-0. View

15.

Tuohy K, Steinman T . Hypercalcemia due to excess 1,25-dihydroxyvitamin D in Crohn's disease. Am J Kidney Dis. 2005; 45(1):e3-6. DOI: 10.1053/j.ajkd.2004.09.008. View

16.

Seymour J, Gagel R . Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin's disease and non-Hodgkin's lymphomas. Blood. 1993; 82(5):1383-94. View

17.

Walls J, Ratcliffe W, Howell A, Bundred N . Parathyroid hormone and parathyroid hormone-related protein in the investigation of hypercalcaemia in two hospital populations. Clin Endocrinol (Oxf). 1994; 41(4):407-13. DOI: 10.1111/j.1365-2265.1994.tb02569.x. View

18.

Tebben P, Singh R, Kumar R . Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment. Endocr Rev. 2016; 37(5):521-547. PMC: 5045493. DOI: 10.1210/er.2016-1070. View

19.

Zemrak F, McNeil L, Peden N . Rennies, Crohn's disease and severe hypercalcaemia. BMJ Case Rep. 2012; 2010. PMC: 3028060. DOI: 10.1136/bcr.07.2010.3138. View

20.

Barre P, Gascon-Barre M, Meakins J, Goltzman D . Hydroxychloroquine treatment of hypercalcemia in a patient with sarcoidosis undergoing hemodialysis. Am J Med. 1987; 82(6):1259-62. DOI: 10.1016/0002-9343(87)90237-3. View