Internal MedicineReading Hospital, Reading, Pennsylvania, USA
Internal MedicineSidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Eur J Endocrinol. 2018 Apr;178(4):425-430. doi: 10.1530/EJE-17-0938. Epub 2018 Feb 16.
Cosmetic injections with silicone and polymethylmethacrylate are not FDA approved for augmentation of body parts such as breast, buttock or legs, but they have been widely used for decades. Cosmetic injections can cause foreign body granulomas and occasionally severe and life-threatening hypercalcemia. We aimed to systematically analyze the published literature on cosmetic injection-associated hypercalcemia.
We searched relevant articles on hypercalcemia associated with various cosmetic injections and extracted relevant data on demographics, cosmetic injections used, severity of hypercalcemia, management and outcomes.
We identified 23 eligible patients from 20 articles. Mean age was 49.83 ± 14.70 years with a female preponderance (78.26% including transgender females). Silicone was most commonly used, followed by polymethylmethacrylate and paraffin oil (43.48, 30.43, and 8.70% respectively). The buttock was the most common site followed by the breast (69.57% and 39.13% respectively). Hypercalcemia developed at mean duration of 7.96 ± 7.19 years from the initial procedure. Mean ionized calcium at presentation was 2.19 ± 0.61 mmol/L and mean corrected calcium at presentation was 3.43 ± 0.31 mmol/L. 1,25-Dihydroxyvitamin D (1,25(OH)D or calcitriol) was elevated while 25-hydroxyvitamin D (25(OH)D) and PTH were low in majority of cases. Hypercalcemia was managed conservatively with hydration, corticosteroids and bisphosphonates in majority of cases. Surgery was attempted in 2 cases but was unsuccessful. Renal failure was the most common complication (82.35% cases) and 2 patients died.
Hypercalcemia from cosmetic injections can be severe and life threatening and can present years after the initial procedure. Cosmetic injection-associated granuloma should be considered a cause of hypercalcemia, especially in middle-aged females presenting with non-PTH-mediated, non-malignant hypercalcemia, which is often associated with elevated calcitriol; however, it should be noted that calcitriol level may be normal as well.
用于乳房、臀部或腿部等身体部位填充的硅胶和聚甲基丙烯酸甲酯等美容注射物并未获得 FDA 的批准，但几十年来它们已被广泛应用。美容注射物可导致异物肉芽肿，偶尔还会引起严重甚至危及生命的高钙血症。我们旨在系统性分析已发表的关于各种美容注射物相关高钙血症的文献。
我们对与各种美容注射物相关的高钙血症相关文章进行检索，并提取有关人口统计学、使用的美容注射物、高钙血症严重程度、治疗和结局的数据。
我们从 20 篇文章中确定了 23 名符合条件的患者。平均年龄为 49.83±14.70 岁，女性居多（包括跨性别女性在内占 78.26%）。硅胶最常被使用，其次是聚甲基丙烯酸甲酯和石蜡油（分别占 43.48%、30.43%和 8.70%）。最常见的注射部位是臀部，其次是乳房（分别占 69.57%和 39.13%）。高钙血症在初次治疗后平均 7.96±7.19 年出现。就诊时平均离子钙为 2.19±0.61mmol/L，平均校正钙为 3.43±0.31mmol/L。大多数情况下，1,25-二羟维生素 D（1,25(OH)D 或骨化三醇）升高，而 25-羟维生素 D（25(OH)D）和甲状旁腺激素（PTH）降低。大多数情况下，高钙血症通过补液、皮质类固醇和双膦酸盐进行保守治疗。有 2 例尝试手术治疗，但均不成功。肾衰竭是最常见的并发症（82.35%的病例），有 2 例患者死亡。
美容注射物引起的高钙血症可能很严重且危及生命，并可能在初次治疗后数年出现。美容注射物相关肉芽肿应被视为高钙血症的原因之一，尤其是在出现非甲状旁腺介导的、非恶性高钙血症的中年女性中，这种情况通常与升高的骨化三醇有关；然而，应该注意的是，骨化三醇水平也可能正常。
