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Plasma-cell granuloma producing calcitriol and hypercalcemia
Annals of Internal Medicine
|September 1, 1986
Summary
A plasma-cell granuloma in a teenage boy caused hypercalcemia by producing calcitriol (1,25-dihydroxyvitamin D3). Surgical removal normalized calcium levels, confirming the granuloma as the source of excess vitamin D.
Area of Science:
- Endocrinology
- Oncology
- Pulmonology
Background:
- Hypercalcemia in adolescents can be challenging to diagnose.
- Intrathoracic masses require thorough investigation for underlying causes.
Observation:
- A teenage male presented with symptomatic hypercalcemia and a significant intrathoracic mass.
- Standard tests for hypercalcemia, including parathyroid hormone levels, were inconclusive.
Findings:
- Surgical resection of a plasma-cell granuloma from the lung lobes resolved the hypercalcemia.
- Pre-operative elevated serum calcitriol (1,25-dihydroxyvitamin D3) normalized post-surgery.
- The resected granuloma tissue synthesized calcitriol in vitro.
Implications:
- Plasma-cell granulomas can ectopically produce calcitriol, leading to hypercalcemia.
- This case highlights an unusual cause of malignancy-associated hypercalcemia.
- Consider granulomatous disease in the differential diagnosis of unexplained hypercalcemia.
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