Abstract

Case Report

Hypercalcemia due to Elevated 1,25 dihydroxyvitamin D in Tophaceous Gout - Case Report and Literature Review

Madhia Ahmad*, Sunnie Lee, Htay Htay Kyi, Shuwei Wang, Smitha Mahendrakar and Michael Yudd

Published: 22 November, 2024 | Volume 8 - Issue 3 | Pages: 142-145

Granulomatous diseases can cause hypercalcemia due to elevated 1,25-dihydroxyvitamin D through the production of 1-α hydroxylase by macrophages in the granulomas. Tophaceous gout is not considered to cause this picture. However, there are a few case reports of this occurrence in tophaceous gout, as well as the description of intense 1-α hydroxylase activity in granulomas of tophi in gout patients. We review this literature, and we report a well-documented case of hypercalcemia with elevated serum 1,25 dihydroxyvitamin D in a patient with extensive tophaceous gout and tophi loaded with granulomas. An extensive work-up ruled out other causes of hypercalcemia and granulomatous diseases. Prednisone corrected the chemical abnormalities. Diffuse tophaceous gout should be considered a rare cause of hypercalcemia due to excessive 1,25 dihydroxy vitamin D.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001143 Cite this Article Read Full Article PDF

References

  1. Walker MD, Shane E. Hypercalcemia: A review. JAMA. 2022;328(16):1624–1636. Available from: https://doi.org/10.1001/jama.2022.18331
  2. Goltzman D. Pathophysiology of hypercalcemia. Endocrinol Metab Clin North Am. 2021;50(4):591-607. Available from: https://doi.org/10.1016/j.ecl.2021.07.008
  3. Motlaghzadeh Y, Bilezikian JP, Sellmeyer DE. Rare causes of hypercalcemia: 2021 update. J Clin Endocrinol Metab. 2021;106(11):3113-3128. Available from: https://doi.org/10.1210/clinem/dgab504
  4. Ungprasert P, Carmona EM, Crowson CS, Matteson EL. Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: A population-based study. Lung. 2016;194(1):91-5. Available from: https://doi.org/10.1007/s00408-015-9826-3
  5. Jacobs TB, Bilezikian JP. Rare causes of hypercalcemia. J Clin Endocrinol Metab. 2005;90:6316–6322. Available from: https://doi.org/10.1210/jc.2005-0675
  6. Gallegos-Bayas G, Pascual-Pareja JF, Sanchez-Niño MD, Manzarbeitia F, Ortiz A. Undetectable serum calcidiol: Not everything that glitters is gold. Clin Kidney J. 2012;5(1):37-40. Available from: https://doi.org/10.1093/ndtplus/sfr121
  7. Rodríguez-Gutiérrez R, Zapata-Rivera MA, Rodriguez-Velver KV, Lavalle-Gonzalez FJ, Gonzalez-Gonzalez JG, Villarreal-Perez JZ. Severe hypercalcemia - Chronic tophaceous gout as the responsible cause? Eur Endocrinol. 2015;11(2):102-104. Available from: https://doi.org/10.17925/ee.2015.11.02.102
  8. Sachdeva A, Goeckeritz BE, Oliver AM. Symptomatic hypercalcemia in a patient with chronic tophaceous gout: A case report. Cases J. 2008;1(1):72. Available from: https://doi.org/10.1186/1757-1626-1-72
  9. Hasbani GE, Megahed A, Cassetta M. When tophaceous gout involves multiple organs: Challenges and solutions. Acta Endocrinol (Buchar). 2023;19(1):131-132. Available from: https://doi.org/10.4183/aeb.2023.131
  10. Lee KA, Yoo WH. Immobilization hypercalcemia-associated acute renal failure in a patient with chronic tophaceous gout. Ren Fail. 2009;31(9):855-7. Available from: https://doi.org/10.3109/08860220903151393
  11. Gudlawar S. Hypercalcemia associated with severe tophaceous gout. Fluids, Electrolytes, and Acid-base Disorders: Clinical. 2023 Nov 4. Pennsylvania. SA-PO965. Available from: https://journals.lww.com/jasn/citation/2023/11001/hypercalcemia_associated_with_severe_tophaceous.3249.aspx
  12. Oelzner P, Lehmann G, Eidner T, Franke S, Müller A, Wolf G, Hein G. Hypercalcemia in rheumatoid arthritis: Relationship with disease activity and bone metabolism. Rheumatol Int. 2006;26(10):908-15. Available from: https://doi.org/10.1007/s00296-005-0095-y

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