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An acromegalic patient with recurrent urolithiasis
Insights
Acromegaly, a condition caused by excess growth hormone (GH), can lead to elevated vitamin D levels and kidney stones. Treating the underlying cause improved these metabolic abnormalities.
Area of Science:
- Endocrinology
- Nephrology
- Metabolic Disorders
Background:
- Acromegaly is characterized by excessive growth hormone (GH) production, leading to various systemic complications.
- Urolithiasis, or kidney stones, is a known complication, often linked to hypercalciuria.
Observation:
- A patient with acromegaly presented with abdominal pain and hematuria due to urolithiasis.
- Investigations revealed hypercalciuria and elevated serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) levels, ruling out hyperparathyroidism.
- Serum calcium and parathyroid hormone (PTH) levels were within normal limits.
Findings:
- Selective adenomectomy to treat the acromegaly normalized 1,25-(OH)2D levels and resolved hypercalciuria and urolithiasis.
- Pre-operative 1,25-(OH)2D levels were significantly elevated (55.0 and 73.0 pg/ml) compared to the normal range (27.2-53.8 pg/ml).
- Post-operative 1,25-(OH)2D levels decreased to 23.0 pg/ml.
Implications:
- Growth hormone (GH) may stimulate vitamin D activation in the kidneys in acromegaly patients.
- This increased vitamin D activation enhances intestinal calcium absorption and urinary calcium excretion.
- Targeting GH excess can effectively manage vitamin D-related metabolic disturbances and urolithiasis in acromegaly.
Abstract:
A 52-year-old man with an acromegalic appearance of prolonged duration suffered abdominal colic attacks and hematuria during the middle of the course of the disease. The patient was diagnosed as having urolithiasis caused by increased urinary calcium. The calcium metabolic disorder was not considered to be due to hyperparathyroidism because serum calcium and PTH levels were within the normal range and no abnormality was observed in a parathyroidal scintigraph. The serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) levels (55.0 and 73.0 pg/ml) were higher than the normal range (27.2-53.8 pg/ml). A selective adenomectomy by the transsphenoidal route (Hardy's method) was performed, resulting in an improvement in the hypercalciuria and urolithiasis, and a decrease in the levels of serum 1,25-(OH)2D (23.0 and 23.0 pg/ml). These findings suggest that GH may promote the activation of vitamin D in the kidney in acromegaly, resulting in an acceleration of calcium absorption in the intestine through the action of activated vitamin D and the induction of increased urinary calcium excretion by the urinary excretion of excessive blood calcium.