Quarles L D, Murphy G, Econs M J, Martinez S, Lobaugh B, Lyles K W
Department of Medicine, Duke University Medical Center, Durham, NC.
Am J Kidney Dis. 1991 Dec;18(6):706-10. doi: 10.1016/s0272-6386(12)80614-7.
Periarticular tumoral calcification is a unique form of soft tissue calcification that occurs infrequently in patients with end-stage renal disease. The mechanism underlying such massive periarticular calcifications is unknown. The radiographic similarity between uremic tumoral calcifications and those found in hereditary tumoral calcinosis, a disorder of calcitriol and phosphorus homeostasis, caused us to examine whether abnormalities in vitamin D metabolism were associated with uremic calcinosis as well. We examined two uremic subjects with massive periarticular tumoral calcifications and found that they had inappropriately high serum calcitriol levels for the degree of renal function, hyperparathyroidism, and hyperphosphatemia. The source of calcitriol could not be identified in one subject, but likely was derived from granulomatous tissue in the other. In the subject with marrow granulomas, we found that calcitonin administration further stimulated calcitriol production. Although epidemiological studies are needed to confirm this preliminary association between calcitriol and uremic tumoral calcinosis, our observations suggest that normal serum calcitriol levels in association with hyperphosphatemia may be a contributing factor in the development of this rare disorder.
关节周围肿瘤性钙化是一种独特的软组织钙化形式，在终末期肾病患者中很少见。这种大量关节周围钙化的潜在机制尚不清楚。尿毒症肿瘤性钙化与遗传性肿瘤性钙沉着症（一种维生素D和磷稳态紊乱疾病）中的钙化在影像学上相似，这促使我们研究维生素D代谢异常是否也与尿毒症性钙化有关。我们检查了两名患有大量关节周围肿瘤性钙化的尿毒症患者，发现就肾功能、甲状旁腺功能亢进和高磷血症程度而言，他们的血清骨化三醇水平过高。在一名患者中无法确定骨化三醇的来源，但在另一名患者中可能来源于肉芽肿组织。在患有骨髓肉芽肿的患者中，我们发现给予降钙素会进一步刺激骨化三醇的产生。虽然需要进行流行病学研究来证实骨化三醇与尿毒症肿瘤性钙化之间的这种初步关联，但我们的观察结果表明，正常血清骨化三醇水平与高磷血症可能是这种罕见疾病发生的一个促成因素。
