Format

Send to

Choose Destination
J Clin Res Pediatr Endocrinol. 2019 May 28;11(2):140-148. doi: 10.4274/jcrpe.galenos.2018.2018.0131. Epub 2018 Nov 5.

Comparison of Treatment Regimens in Management of Severe Hypercalcemia Due to Vitamin D Intoxication in Children

Author information

1
Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
2
Atatürk University Faculty of Medicine, Department of Children’s Health and Disease, Erzurum, Turkey
3
Ondokuz Mayıs University Faculty of Medicine, Department of Children’s Health and Disease, Samsun, Turkey
4
Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
5
University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease, Health Implementation and Research Center, Ankara, Turkey
6
Erzurum State Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
7
Adnan Menderes University Faculty of Medicine, Department of Children’s Health and Disease, Aydın, Turkey
8
Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
9
Ankara Children’s Hematology and Oncology Training Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
10
Kırıkkale University Faculty of Medicine, Department of Children’s Health and Disease, Kırıkkale, Turkey
11
Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
12
Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
13
University of Health Sciences Dr. Behçet Uz Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey

Abstract

Objective:

No large study has been conducted to date to compare the effectiveness of prednisolone, alendronate and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. The aim was to perform a multicenter, retrospective study assessing clinical characteristics and treatment results.

Methods:

A standard questionnaire was uploaded to an online national database system to collect data on children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication [serum 25-hydroxyvitamin D (25(OH)D) level >150 ng/mL] who were treated in pediatric endocrinology clinics.

Results:

Seventy-four children [median (range) age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. High-dose vitamin D intake was evident in 77% of the cases. At diagnosis, serum calcium, phosphorus, alkaline phosphatase, 25(OH)D and parathyroid hormone concentrations were 15±3.2 mg/dL, 5.2±1.2 mg/dL, 268±132 IU/L, 322 (236-454) ng/mL, and 5.5 (3-10.5) pg/mL, respectively. Calcium levels showed moderate correlation with 25(OH)D levels (rs=0.402, p<0.001). Patients were designated into five groups according to the initial specific treatment regimens (hydration-only, prednisolone, alendronate, pamidronate, and combination). Need for another type of specific drug treatment was higher in children who initially received prednisolone (p<0.001). Recurrence rate of hypercalcemia was significantly lower in children who were treated with pamidronate (p=0.02).

Conclusion:

Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens should be considered.

KEYWORDS:

Nutrition; rickets; stoss therapy; steroid; over-the-counter drugs

Free full text

Supplemental Content

Full text links

Icon for Galenos Yayinevi
Loading ...
Support Center