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Undetectable serum calcidiol: not everything that glitters is gold.

Gallegos-Bayas G, Pascual-Pareja JF, Sanchez-Niño MD, Manzarbeitia F, Ortiz A - Clin Kidney J (2012)

Bottom Line: There is an increased awareness of the adverse consequences of nutritional vitamin D deficiency.Upon recovery, serum 1,25(OH)2 vitamin D remained in the normal range despite CKD and serum 25(OH) vitamin D 6 ng/mL.This case illustrates the dangers of supplementing vitamin D in patients with low serum 25(OH) vitamin D and increased 1α-hydroxylase activity due to granulomatous disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Family and Community Medicine, Centro de Salud Barrio del Pilar, Area 5, Madrid, Spain.

ABSTRACT
There is an increased awareness of the adverse consequences of nutritional vitamin D deficiency. We report a patient with chronic tophaceous gout, chronic kidney disease (CKD) Stage 3/4 and undetectable serum calcidiol who developed severe hypercalcaemia upon vitamin D supplementation despite serum 25(OH) vitamin D within the normal range. Upon recovery, serum 1,25(OH)2 vitamin D remained in the normal range despite CKD and serum 25(OH) vitamin D 6 ng/mL. Gout tophi biopsies from additional patients showed macrophage expression of 25(OH) vitamin D 1α-hydroxylase. This case illustrates the dangers of supplementing vitamin D in patients with low serum 25(OH) vitamin D and increased 1α-hydroxylase activity due to granulomatous disease.

No MeSH data available.


Related in: MedlinePlus

Extensive severe tophaceous gout. (A) Extensive tophi in both hands. (B) Extensive gluteal tophi. (C) CT scan imaging of hypervascularized gouty tophi in buttocks. The nature of the lesions was confirmed by fine needle aspiration biopsy.
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fig1: Extensive severe tophaceous gout. (A) Extensive tophi in both hands. (B) Extensive gluteal tophi. (C) CT scan imaging of hypervascularized gouty tophi in buttocks. The nature of the lesions was confirmed by fine needle aspiration biopsy.

Mentions: Physical findings included disorientation and extensive, severe tophi in hands, elbows, arms, thighs and gluteus (Figure 1A and B). Key analytical values were normocytic normochromic anaemia, serum creatinine (sCr) 185 μmol/L (2.1 mg/dL), uric acid 618 μmol/L (10.4 mg/dL), calcaemia 3.5 mmol/L (14 mg/dL) [ionized Ca 1.87 mmol/L (7.52 mg/dL)], iPTH <3 ng/L), 25(OH) vitamin D 187 nmol/L (75 ng/mL) [normal range 37–250 nmol/L (15–100 ng/mL)], angiotensin-converting enzyme (ACE) 110.4 U/L (normal range 20–60), normal thyroid hormones and absence of anti-nuclear antibodies. There was no evidence of cancer in serum tumour markers, proteinogram, axillary lymph node biopsy, gastroscopy, colonoscopy, bone marrow biopsy, abdominal sonography, bone gammagraphy and neck, thorax, abdomen and pelvis CT scan. The CT scan showed vascular enhancement in the subcutaneous tissue in both buttocks (Figure 1C). Fine needle aspiration biopsy of the buttock lesions showed uric acid crystals.


Undetectable serum calcidiol: not everything that glitters is gold.

Gallegos-Bayas G, Pascual-Pareja JF, Sanchez-Niño MD, Manzarbeitia F, Ortiz A - Clin Kidney J (2012)

Extensive severe tophaceous gout. (A) Extensive tophi in both hands. (B) Extensive gluteal tophi. (C) CT scan imaging of hypervascularized gouty tophi in buttocks. The nature of the lesions was confirmed by fine needle aspiration biopsy.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400450&req=5

fig1: Extensive severe tophaceous gout. (A) Extensive tophi in both hands. (B) Extensive gluteal tophi. (C) CT scan imaging of hypervascularized gouty tophi in buttocks. The nature of the lesions was confirmed by fine needle aspiration biopsy.
Mentions: Physical findings included disorientation and extensive, severe tophi in hands, elbows, arms, thighs and gluteus (Figure 1A and B). Key analytical values were normocytic normochromic anaemia, serum creatinine (sCr) 185 μmol/L (2.1 mg/dL), uric acid 618 μmol/L (10.4 mg/dL), calcaemia 3.5 mmol/L (14 mg/dL) [ionized Ca 1.87 mmol/L (7.52 mg/dL)], iPTH <3 ng/L), 25(OH) vitamin D 187 nmol/L (75 ng/mL) [normal range 37–250 nmol/L (15–100 ng/mL)], angiotensin-converting enzyme (ACE) 110.4 U/L (normal range 20–60), normal thyroid hormones and absence of anti-nuclear antibodies. There was no evidence of cancer in serum tumour markers, proteinogram, axillary lymph node biopsy, gastroscopy, colonoscopy, bone marrow biopsy, abdominal sonography, bone gammagraphy and neck, thorax, abdomen and pelvis CT scan. The CT scan showed vascular enhancement in the subcutaneous tissue in both buttocks (Figure 1C). Fine needle aspiration biopsy of the buttock lesions showed uric acid crystals.

Bottom Line: There is an increased awareness of the adverse consequences of nutritional vitamin D deficiency.Upon recovery, serum 1,25(OH)2 vitamin D remained in the normal range despite CKD and serum 25(OH) vitamin D 6 ng/mL.This case illustrates the dangers of supplementing vitamin D in patients with low serum 25(OH) vitamin D and increased 1α-hydroxylase activity due to granulomatous disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Family and Community Medicine, Centro de Salud Barrio del Pilar, Area 5, Madrid, Spain.

ABSTRACT
There is an increased awareness of the adverse consequences of nutritional vitamin D deficiency. We report a patient with chronic tophaceous gout, chronic kidney disease (CKD) Stage 3/4 and undetectable serum calcidiol who developed severe hypercalcaemia upon vitamin D supplementation despite serum 25(OH) vitamin D within the normal range. Upon recovery, serum 1,25(OH)2 vitamin D remained in the normal range despite CKD and serum 25(OH) vitamin D 6 ng/mL. Gout tophi biopsies from additional patients showed macrophage expression of 25(OH) vitamin D 1α-hydroxylase. This case illustrates the dangers of supplementing vitamin D in patients with low serum 25(OH) vitamin D and increased 1α-hydroxylase activity due to granulomatous disease.

No MeSH data available.


Related in: MedlinePlus