FRACP, Department of Internal Medicine and Aged Care, Level 3, DJM Building, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia.
J Clin Endocrinol Metab. 2013 Oct;98(10):4023-9. doi: 10.1210/jc.2013-2016. Epub 2013 Aug 26.
Hypercalcemia mediated by 1,25-dihydroxy vitamin D (calcitriol) is uncommon, with evidence on etiology limited to small case series or case reports.
The objective of the study was to systematically identify a large series of cases of calcitriol-mediated hypercalcemia and document the presentation, demographics, and clinical course across etiologies.
DESIGN, SETTING, AND PATIENTS: The study was a hospital-based, retrospective case series, identifying subjects from 1999 through 2009 across the public hospital system in Queensland, Australia. All patients aged over 18 years were identified that had persistent hypercalcemia associated with elevated or inappropriately normal calcitriol concentration or elevated serum angiotensin-converting enzyme.
A total of 101 cases were identified. Sarcoidosis was the most common etiology (49%), followed by hematological malignancy (17%) and infections (8%). Etiologies not previously described include squamous cell carcinoma of the tongue, ovarian cystadenocarcinoma, and chronic lymphocytic leukemia. Median serum angiotensin-converting enzyme was higher in sarcoid patients compared with all other causes [218 U/L (176-277) vs 155 U/L (110-208), P < .001], but a level above the normal range did not discriminate well between cases of sarcoidosis and other causes (specificity at cutoff of 130 U/L was only 31%). However, a value greater than 250 U/L was highly specific (89%) for sarcoidosis but lacked sensitivity (31%). A calcitriol level greater than 300 pmol/L was not seen in sarcoidosis but was seen with other etiologies. Cases with neoplastic etiologies were older (61.4 ± 11.4 y) than all other subjects (51.7 ± 15.0 y, P = .006).
Hypercalcemia mediated by calcitriol remains a rare presentation. In almost half the cases, sarcoidosis was the underlying cause, whereas a third of patients had cancer or systemic infections.
1,25-二羟维生素 D（骨化三醇）介导的高钙血症并不常见，病因学证据仅限于小病例系列或病例报告。
本研究的目的是系统地识别大量骨化三醇介导的高钙血症病例，并记录各种病因的表现、人口统计学和临床过程。
设计、地点和患者：本研究是一项基于医院的回顾性病例系列研究，于 1999 年至 2009 年在澳大利亚昆士兰州的公立医院系统中确定了年龄超过 18 岁的所有持续性高钙血症患者，这些患者的血钙浓度升高或不适当升高，伴有骨化三醇浓度升高或血清血管紧张素转换酶升高。
共确定了 101 例病例。结节病是最常见的病因（49%），其次是血液系统恶性肿瘤（17%）和感染（8%）。以前未描述的病因包括舌鳞状细胞癌、卵巢囊腺癌和慢性淋巴细胞白血病。与其他所有病因相比，结节病患者的中位血清血管紧张素转换酶更高[218 U/L（176-277）比 155 U/L（110-208），P<0.001]，但正常范围内的水平并不能很好地区分结节病和其他病因（在截定点为 130 U/L 时的特异性仅为 31%）。然而，大于 250 U/L 的值高度提示结节病（特异性 89%），但敏感性低（31%）。结节病患者中未发现骨化三醇水平大于 300 pmol/L，但其他病因中可见。有肿瘤病因的病例年龄较大（61.4±11.4 岁），比所有其他患者（51.7±15.0 岁，P=0.006）大。
骨化三醇介导的高钙血症仍然是一种罕见的表现。近一半的病例是由结节病引起的，而三分之一的患者患有癌症或全身性感染。
