Abstract
Growth hormone excess has been associated with hypercalciuria and nephrolithiasis. Hypercalcemia in acromegaly is rare and usually due to coexistent primary hyperparathyroidism. To report two cases of 1,25-dihydroxyvitamin D (1,25 (OH)2 D)-dependent hypercalcemia in cromegaly. A 50 year-old female with 2 years history of hypercalcemia presented with features of acromegaly. Serum calcium (Ca) was 10.9 mg/dl (8.6–10.2), parathyroid hormone (PTH) 20 pg/ml (10–65), PTH-related peptide undetectable, and 1,25 (OH)2 D 119 pg/ml (15–75). Insulin-like growth factor 1 (IGF1) was 911 ng/ml (49–292) and growth hormone (GH) 14.5 ng/ml (0.03–10). MRI showed a 1.7 cm pituitary tumor. Transsphenoidal adenectomy (TSA) resulted in normalization of IGF1, GH, Ca, and 1,25 (OH)2 D (50 pg/ml) and complete tumor resection. A 52-year-old female was diagnosed with visual field deficits on routine exam. MRI showed a 3 cm invasive pituitary macroadenoma. IGF1 was 416 ng/ml (87–238) and GH 75.8 (0–6.0) ng/ml. Incidentally, she was found with high Ca of 10.8 mg/dl (8.9–10.3) associated with PTH 19 pg/ml and 1,25 (OH)2 D66 pg/ml. Postoperatively, IGF1 and GH remained abnormal (440 and 12.8 ng/ml, respectively), while MRI showed parasellar tumor residue. Ca remained high (10.1–11.1 mg/dl), along with elevated 1,25 (OH)2 D level (81.3 pg/ml). In both cases, other causes of hypercalcemia were ruled out. We present 2 cases of 1,25 (OH)2 D-dependent hypercalcemia associated with growth hormone excess. Complete resection of tumor produced biochemical remission of acromegaly and normalization of calcium and 1,25 (OH)2 D levels, while incomplete resection was associated with persistent 1,25 (OH)2 D-dependent hypercalcemia. Acromegaly should be considered a cause of 1,25 (OH)2 D-dependent hypercalcemia.
Abbreviations
- ACE:
-
Angiotensin-1 converting enzyme
- Alk Phos:
-
Alkaline phosphatase
- Ca:
-
Calcium
- GH:
-
Growth hormone
- IGF1:
-
Insulin-like growth factor 1
- PTH:
-
Parathyroid hormone
- PTHrP:
-
Parathyroid hormone-related protein
- TSA:
-
Transsphenoidal adenectomy
- UCa:
-
Urinary calcium
- 1,25 (OH)2 D:
-
1,25-dihydroxyvitamin D
- 25-OH vit D:
-
25-hydroxyvitamin D
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Shah, R., Licata, A., Oyesiku, N.M. et al. Acromegaly as a cause of 1,25-dihydroxyvitamin D-dependent hypercalcemia: case reports and review of the literature. Pituitary 15 (Suppl 1), 17–22 (2012). https://doi.org/10.1007/s11102-010-0286-8
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DOI: https://doi.org/10.1007/s11102-010-0286-8