Jalbert M, Mignot A, Gauchez A-S, Dobrokhotov A-C, Fourcade J
Service d'endocrinologie et diabétologie, CHU Grenoble-Alpes, 38700 La Tronche, France; Service de néphrologie, centre hospitalier métropole Savoie, 73000 Chambéry, France.
Service de néphrologie, centre hospitalier métropole Savoie, 73000 Chambéry, France.
Nephrol Ther. 2018 Jun;14(4):231-236. doi: 10.1016/j.nephro.2018.03.003. Epub 2018 Apr 27.
Hypercalcemia is not a rare event and can lead to severe consequences. Its main etiologies are primary hyperparathyroidism and neoplasic conditions. The iatrogenic etiology by vitamin D intoxication is more rarely found.
A 76-year-old finish woman comes to the emergency room for chest pain. Her medical history is impossible to specify due to the language barrier and initial confusion. She has severe hypercalcaemia (4.14mmol/L), renal insufficiency, cardiac arrhythmia later complicated by an ischemic cardiac episode. Clinic and biologic examinations initially guided the research towards a hematological and neoplasic pathology. The iatrogenic etiology will be permitted by the contribution of details on its medical history and treatment learnt secondly. She was treated for post-surgical hypoparathyroidism by dihydrotachysterol, a vitamin D derivative. The cessation of substitution, treatment with hydration and biphosphonates allowed the rapid correction of hypercalcemia.
Dihydrotachysterol intoxication is a rare etiology of hypercalcemia. Because of the longer half-life of this molecule, the risk of hypercalcemia seems to be greater than with other vitamin D derivatives. This molecule, withdrawn from the French market in 1982, is not detected by the dosage of 25 and 1.25 OH vitamin D.
We report an original case of intoxication by dihydrotachysterol. The risk of hypercalcemia encountered with this molecule must be known. The close medical follow-up recommended in case of hypoparathyroidism seems to be particularly necessary in case of supplementation by this molecule.
高钙血症并非罕见病症，可导致严重后果。其主要病因是原发性甲状旁腺功能亢进和肿瘤性疾病。维生素D中毒导致的医源性病因较为少见。
一名76岁的芬兰女性因胸痛前往急诊室。由于语言障碍和初期的意识混乱，其病史难以明确。她患有严重的高钙血症（4.14mmol/L）、肾功能不全，后期出现心律失常并并发缺血性心脏事件。临床和生物学检查最初将研究方向指向血液学和肿瘤性病理。通过后续了解到的病史和治疗细节，确定了医源性病因。她曾使用维生素D衍生物双氢速甾醇治疗术后甲状旁腺功能减退。停用替代治疗、进行补液和双膦酸盐治疗后，高钙血症得以迅速纠正。
双氢速甾醇中毒是高钙血症的罕见病因。由于该分子的半衰期较长，高钙血症的风险似乎比其他维生素D衍生物更大。该分子于1982年从法国市场撤出，通过检测25羟维生素D和1,25二羟维生素D无法发现它。
我们报告了一例双氢速甾醇中毒的原始病例。必须了解该分子所带来的高钙血症风险。对于甲状旁腺功能减退患者，若使用该分子进行补充治疗，密切的医学随访似乎尤为必要。
