Abstract
A 58-year-old woman presented with a symptomatic, hypertensive crisis, acute kidney failure AKIN2 and a severe hypercalcemia. The parathyroid hormone levels were in the lower normal range with highly elevated Vitamin D levels. For more than half a year she was taking 100'000 IU Vitamin D daily. Under volume loading, calcium-low-diet, Denosumab for blocking calcium resorption from bone and Ketoconazol to inhibit activation of Vitamin D a normalization of the calcium levels as well as an improvement of renal function could be observed. Loss-of-function mutations in the genes CYP24A1 and SLC34A1, involved in vitamin D metabolism leading to hypercalcemia could not be found in this patient.
ZUSAMMENFASSUNG
Eine 58-jährige Patientin stellte sich notfallmäßig mit einer symptomatischen, hypertensiven Krise, akuter Niereninsuffizienz AKIN 2 und schwerer Hyperkalzämie vor. Das Parathormon war tiefnormal bei deutlich erhöhten Vitamin-D-Spiegeln. Bei gezielter Anamnese konnte eruiert werden, dass die Patientin seit mehr als einem halben Jahr täglich 100.000 IE Vitamin D einnimmt. Unter Volumengabe, kalziumarmer Diät, Denosumab zur Inhibierung der Kalziumresorption aus dem Knochen sowie Ketoconazol zur Hemmung der Vitamin-D-Aktivierung normalisierten sich die Kalziumwerte und verbesserte sich die Nierenfunktion. Eine Funktionsverlustmutation in den Vitamin-D-Stoffwechsel-Genen CYP24A1 und SLC34A1, welche zu einer Hyperkalzämie führen können, konnte bei der Patientin nicht nachgewiesen werden.
Schlüsselwörter: Hyperkalzämie - Vitamin-D-Intoxikation - Vitamin-D- und Kalziumstoffwechsel - CYP24A1 - SCL34A1
Eingereicht am 6.4.2020 - Revision akzeptiert am 9.5.2020
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Frischknecht, L., von Rappard, J. Schwere Vitamin-D-Intoxikation. MMW - Fortschritte der Medizin 162 (Suppl 7), 15–18 (2020). https://doi.org/10.1007/s15006-020-4502-9
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DOI: https://doi.org/10.1007/s15006-020-4502-9