Hypercalcemia and human nature
Ashman, N.; Malluche, H.H.; Cunningham, J.
Clinical Nephrology 55(4): 327-330
2001
ISSN/ISBN: 0301-0430 PMID: 11334321 Document Number: 527288
Patients on hemodialysis may develop severe and symptomatic hypercalcemia if skeletal buffering is ineffective. We report a case of persistent hypercalcemia with apparent extrarenal vitamin D synthesis. Associated aluminium intoxication was suggested on desferrioxamine challenge and adynamic uremic osteodystrophy confirmed on bone biopsy. Plasma calcitriol did not suppress with corticosteroids but did with ketoconazole. No other evidence for underlying granulomatous disease was found. We discuss our approach to less usual causes of hypercalcemia, and emphasise the pitfalls associated with factitious disorders.