Acromegaly as a cause of 1,25-dihydroxyvitamin D-dependent hypercalcemia: case reports and review of the literature

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• 作者：Reshma Shah (1)
  Angelo Licata (2) (3)
  Nelson M. Oyesiku (1) (4)
  Adriana G. Ioachimescu (1) (4)
  
• 关键词：Acromegaly ; Hypercalcemia ; Vitamin D ; Growth hormone ; Insulin ; like growth factor 1
• 刊名：Pituitary
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：15
• 期：1/suppl
• 页码：17-22
• 全文大小：271KB
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• 作者单位：Reshma Shah (1)
  Angelo Licata (2) (3)
  Nelson M. Oyesiku (1) (4)
  Adriana G. Ioachimescu (1) (4)
  
  1. Division of Endocrinology, Diabetes and Lipids. Department of Medicine, Emory University School of Medicine, 1365 B Clifton Rd NE, Atlanta, GA, 30329, USA
  2. Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, 44195, USA
  3. Center for Space Medicine, Cleveland Clinic, Cleveland, OH, 44195, USA
  4. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, 30329, USA
  
• ISSN：1573-7403

文摘

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 (8.6-0.2), parathyroid hormone (PTH) 20?pg/ml (10-5), PTH-related peptide undetectable, and 1,25 (OH)2 D 119?pg/ml (15-5). Insulin-like growth factor 1 (IGF1) was 911?ng/ml (49-92) and growth hormone (GH) 14.5?ng/ml (0.03-0). 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 (87-38) and GH 75.8 (0-.0) ng/ml. Incidentally, she was found with high Ca of 10.8?mg/dl (8.9-0.3) 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 (10.1-1.1?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.