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Symptomatic hypercalcemia in the first months of life: calcium-regulating hormones and treatment
P Ghirri1, U Bottone, L Coccoli
1Divisione di Neonatologia, Università di Pisa, Ospedale S. Chiara, Italy.
Insights
Neonatal hypercalcemia, a rare condition, can cause significant infant health issues. Prompt diagnosis and treatment are crucial, involving analysis of calcium-regulating hormones to determine the cause.
Area of Science:
- Pediatrics
- Endocrinology
- Neonatology
Background:
- Neonatal hypercalcemia is a rare disorder with often unknown causes.
- Untreated, it can lead to severe central nervous system and renal damage in infants.
Observation:
- Three infants with symptomatic neonatal hypercalcemia were studied.
- Cases included transient hyperparathyroidism, Williams syndrome, and subcutaneous fat necrosis with hypercalcemia.
Findings:
- One infant showed high intact parathyroid hormone (iPTH) levels indicating transient hyperparathyroidism.
- Another presented with features of incomplete Williams syndrome.
- The third case exhibited hypercalcemia linked to high 1,25(OH)2D levels and suppressed iPTH, suggesting unregulated extrarenal production.
Implications:
- Early identification and treatment of neonatal hypercalcemia are vital to prevent long-term complications.
- Investigating calcium-regulating hormones before treatment is essential for understanding pathogenesis and guiding therapy.
Abstract:
Neonatal hypercalcemia is a rare condition often of unclear pathogenesis. If unrecognized and untreated it may result in central nervous system and renal damage. We studied three infants with symptomatic neonatal hypercalcemia pointing out pathogenetic and therapeutic aspects. One infant was found to have transient hyperparathyroidism with high intact parathyroid hormone (iPTH) levels. One infant had an incomplete form of Williams syndrome with hypercalcemia and an elfin facies. The pathogenesis is unclear in this case. A reduced secretion of calcitonin or an hypersensitivity to vitamin D might be the underlying defect. The third case was found to have subcutaneous fat necrosis and hypercalcemia associated with high 1,25(OH)2D levels and suppressed iPTH levels. These findings suggest an unregulated extrarenal 1,25(OH)2D production. These infants were treated with hydratation, furosemide, corticosteroids and low calcium diet. Symptomatic neonatal hypercalcemia should be treated promptly. However blood has to be taken before starting treatment to study calcium-regulating hormones and clarify pathogenesis.