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A patient with severe hypercalcemia in multiple organ dysfunction syndrome: Role of elevated circulating 1α,25(OH)2vitamin D levels

  1. Junichiro James Kazama1,2,*,
  2. Takashi Yamamoto2,
  3. Hiroshi Oya1,3,
  4. Satoshi Yamamoto3,
  5. Yoshinobu Sato3,
  6. Junko Sakurada4,
  7. Tadayuki Honda1,
  8. Hiroshi Endoh1,
  9. Ichiei Narita2

Article first published online: 14 JAN 2010

DOI: 10.1002/jbmr.18

Issue

Journal of Bone and Mineral Research

Journal of Bone and Mineral Research

Volume 25, Issue 6, pages 1455–1459, June 2010

Additional Information

How to Cite

Kazama, J. J., Yamamoto, T., Oya, H., Yamamoto, S., Sato, Y., Sakurada, J., Honda, T., Endoh, H. and Narita, I. (2010), A patient with severe hypercalcemia in multiple organ dysfunction syndrome: Role of elevated circulating 1α,25(OH)2vitamin D levels. J Bone Miner Res, 25: 1455–1459. doi: 10.1002/jbmr.18

Author Information

  1. 1

    Division of Critical and Intensive Care Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan

  2. 2

    Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

  3. 3

    Division of Digestive Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan

  4. 4

    Division of Cellular and Molecular Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

*Division of Nephrology and Intensive Care Medicine, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-Dori, Niigata, Niigata 951-8510, Japan.

Publication History

  1. Issue published online: 27 MAY 2010
  2. Article first published online: 14 JAN 2010
  3. Accepted manuscript online: 14 JAN 2010 12:00AM EST
  4. Manuscript Accepted: 29 DEC 2009
  5. Manuscript Revised: 16 NOV 2009
  6. Manuscript Received: 20 AUG 2009

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Keywords:

  • sepsis;
  • systemic inflammatory response syndrome;
  • multiple organ dysfunction syndrome;
  • hypercalcemia;
  • 1α,25- dihydroxyvitamin D

Abstract

A 54-year-old man was transferred to our ICU because of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). He died after 38 days of intensive care. During treatment, his serum calcium (Ca) levels continued to increase and reached 3.95 mmol/L, while the ionized Ca levels reached 2.30 mmol/L before his death. He presented with severe kidney injury, pancreatitis, and hemorrhagic gastric erosion that worsened his prognosis; these were possibly associated with the hypercalcemia. His circulating 1α,25-dihydroxyvitamin D [1,25(OH)2D] level was elevated (75.7 to 204 pg/mL), whereas the levels of 25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone–related peptide were not. Liver histology revealed immunoreactivity for 25-hydroxyvitamin D 1α-hydroxylase (CYP27B1) in some of the hepatocytes, in which the localization pattern was similar to that of lysozyme-positive hepatocytes. Our ICU has previously encountered 22 similar MODS patients who presented with hypercalcemia over the last 8 years. SIRS with severe kidney and liver injuries are common clinical findings in hypercalcemic patients with MODS. Of the 23 hypercalcemic MODS patients, including the present patient, 17 had circulating 1,25(OH)2D levels exceeding 70 pg/mL despite severe kidney injury. Extrarenal activation of CYP27B1 seems to play a role in the development of hypercalcemia in this disease condition. Clinicians need to be aware that severe hypercalcemia may occur in MODS patients. © 2010 American Society for Bone and Mineral Research

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