Godasi Bramara N, Schade David S
Department of Endocrinology and Metabolism, University of New Mexico Health Sciences, Albuquerque, NM 87131, USA.
JCEM Case Rep. 2025 Mar 19;3(4):luaf050. doi: 10.1210/jcemcr/luaf050. eCollection 2025 Apr.
Excessive 1, 25-dihydroxy vitamin D (calcitriol) is a pathophysiological cause of hypercalcemia. This form of hypercalcemia is seen in autoimmune conditions, fungal infections, lymphoma, and rare genetic diseases. A factious disorder manifesting as intentional ingestion of calcitriol leading to hypercalcemia has not been previously reported. We report a case of a female in the fourth decade with recurrent episodes of hypercalcemia seen at multiple clinics across the United States over a period of 20 years. Several extensive medical workups were unable to identify a specific cause of her non-PTH mediated hypercalcemia. We used a novel approach to determine that her hypercalcemia was secondary to exogenous calcitriol administration. When the patient realized that the etiology had been identified, she refused all further contact with the physician. It is not uncommon for patients with a factitious disorder to deny self-inflicting behavior or to seek care somewhere else. Ingestion of calcitriol should be considered when the etiology of recurrent hypercalcemia cannot be identified by traditional medical testing.
过量的1,25 - 二羟维生素D（骨化三醇）是高钙血症的病理生理原因。这种形式的高钙血症见于自身免疫性疾病、真菌感染、淋巴瘤和罕见的遗传疾病。此前尚未报道过一种伪装成故意摄入骨化三醇导致高钙血症的做作性障碍。我们报告一例40岁左右的女性病例，在20年的时间里，她在美国多家诊所反复出现高钙血症发作。多次广泛的医学检查未能确定她非甲状旁腺激素介导的高钙血症的具体病因。我们采用了一种新颖的方法来确定她的高钙血症是外源性骨化三醇给药所致。当患者意识到病因已被查明时，她拒绝与医生再有任何联系。做作性障碍患者否认自我伤害行为或去其他地方寻求治疗的情况并不少见。当传统医学检测无法确定反复性高钙血症的病因时，应考虑骨化三醇摄入的可能性。
