Universidade Federal de Goiás, Departamento de Medicina Interna, Divisão de Endocrinologia, Goiânia, GO, Brasil.
Centro de Diagnóstico por Imagem (CDI), Departamento de Medicina Nuclear, Goiânia, GO, Brasil.
Arch Endocrinol Metab. 2023 Mar 30;67(3):450-455. doi: 10.20945/2359-3997000000591.
Hypercalcemia is a frequent condition in clinical practice and when the most frequent causes are excluded, etiological diagnosis can be challenging. A rare cause of PTH-independent hypercalcemia is described in the present case report. A male adult with a history of androgenic-anabolic steroids abuse, and injection of mineral oil and oily veterinary compound containing vitamins A, D and E into muscles for local hypertrophy presented with hypercalcemia, nephrocalcinosis, and end-stage renal disease. On physical examination, the presence of calcified subcutaneous nodules and calcification of musculature previously infused with oily substances drew attention. Laboratory tests confirmed hypercalcemia of 12.62 mg/L, low levels of PTH (10 pg/mL), hyperphosphatemia (6.0 mg/dL), 25(OH)D of 23.3 ng/mL, and elevated 1,25(OH)2D (138 pg/mL). Imaging exams showed diffuse calcification of muscle tissue, subcutaneous tissue, and organs such as the heart, lung, and kidneys. The patient was diagnosed with PTH-independent hypercalcemia secondary to foreign body reaction in areas of oil injection. The patient underwent treatment with hydrocortisone for 10 days, single dose zoledronic acid and hemodialysis. He evolved with serum calcium levels of 10.4 mg/dL and phosphorus of 7.1 mg/dL. In addition, sertraline and quetiapine were prescribed to control body dysmorphic disorder. The medical community should become aware of new causes of hypercalcemia as secondary to oil injection since this should become increasingly frequent due to the regularity with which such procedures have been performed.
高钙血症是临床实践中的一种常见病症，当最常见的病因被排除后，病因诊断可能具有挑战性。本病例报告描述了一种甲状旁腺素非依赖性高钙血症的罕见病因。一名成年男性有雄激素-合成代谢类固醇滥用史，并向肌肉内注射矿物油和含有维生素 A、D 和 E 的油性兽医化合物，以实现局部肥大，出现高钙血症、肾钙质沉着症和终末期肾病。体格检查时，注意到存在钙化的皮下结节和先前注入油性物质的肌肉钙化。实验室检查证实血钙为 12.62mg/L，甲状旁腺素（PTH）水平低（10pg/mL），高磷血症（6.0mg/dL），25（OH）D 为 23.3ng/mL，1,25（OH）2D 升高（138pg/mL）。影像学检查显示肌肉组织、皮下组织和心脏、肺和肾脏等器官弥漫性钙化。该患者被诊断为甲状旁腺素非依赖性高钙血症，继发于油性物质注射部位的异物反应。患者接受了 10 天的氢化可的松治疗、单次唑来膦酸和血液透析。他的血钙水平降至 10.4mg/dL，磷水平降至 7.1mg/dL。此外，还开具了舍曲林和喹硫平来控制身体变形障碍。由于此类手术的常规性，由于油性物质注射引起的继发性高钙血症的新病因应该会越来越频繁，因此医学领域应该意识到这一点。
