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Idiopathic infantile hypercalcemia: rapid response to treatment with calcitonin
U Alon1, D Berkowitz, M Berant
1Division of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri, Kansas City.
Insights
Idiopathic infantile hypercalcemia in an infant was successfully treated with calcitonin and thiazides. This suggests a maturational delay in calcium homeostasis may be the cause.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Calcium Metabolism
Background:
- Idiopathic infantile hypercalcemia presents a diagnostic challenge.
- Understanding calcium-regulating hormone profiles is crucial for diagnosis and treatment.
Observation:
- A 7-week-old infant presented with hypercalcemia, hypercalciuria, and nephrocalcinosis.
- Hormonal analysis revealed inappropriately high parathyroid hormone and 1,25(OH)2D3, and low calcitonin and 24,25(OH)2D3 levels.
Findings:
- Calcitonin treatment rapidly normalized serum calcium levels.
- Thiazides and a modified diet corrected hypercalciuria.
- Hormonal profiles normalized by 5.5 months of age.
Implications:
- The case suggests a possible generalized maturational delay in calcium homeostasis as a cause of infantile hypercalcemia.
- Calcitonin appears to be an effective treatment for controlling hypercalcemia in such cases.
Abstract:
We report on a 7-week-old infant with idiopathic hypercalcemia, hypercalciuria and nephrocalcinosis. At the time of admission, serum concentrations of parathyroid hormone and 1,25(OH)2D3 were found to be inadequately high, and those of calcitonin and 24,25(OH)2D3 too low, relative to the hypercalcemia. Treatment with calcitonin normalized serum calcium concentrations within 4 days, and a 3-week course of thiazides combined with a decreased dietary calcium:phosphorus ratio corrected the hypercalciuria. A repeat profile of the calcium-regulating hormones done at the age of 5.5 months was normal. Based on the clinical course and the hormonal profiles, we hypothesize that the idiopathic infantile hypercalcemia in this patient could have resulted from a generalized maturational delay of calcium homeostasis. Treatment with calcitonin, therefore, seems to be the most appropriate way to control the hypercalcemia.