Original Article

Comparison of Treatment Regimens for the Management of Severe Hypercalcemia due to Vitamin D Intoxication in Children

10.4274/jcrpe.0131

  • Korcan Demir
  • Hakan Döneray
  • Cengiz Kara
  • Zeynep Atay
  • Semra Çetinkaya
  • Atilla Çayır
  • Ahmet Anık
  • Erdal Eren
  • Ahmet Uçaktürk
  • Gülay Can Yılmaz
  • Ayça Törel Ergür
  • Mustafa Kendirci
  • Zehra Aycan
  • Abdullah Bereket
  • Murat Aydın
  • Zerrin Orbak
  • Behzat Özkan

Received Date: 18.05.2018 Accepted Date: 23.10.2018 J Clin Res Pediatr Endocrinol 0;0(0):0-0 [e-Pub] PMID: 30396880

Background/Aims:

No large study has been conducted so far to compare the efficiencies of prednisolone, alendronate, and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. We aimed 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 of children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication (serum 25-hydroxyvitamin D level >150 ng/mL) who were treated in pediatric endocrinology clinics.

Results:

Seventy-four children [median age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. High-dose vitamin D intake was obvious in 77% of the cases. At diagnosis, serum calcium, phosphorus, ALP, 25-hydroxyvitamin D, and PTH levels 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 only weak correlation with 25-hydroxyvitamin 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:

In mild cases, prednisolone or bisphosphonate treatments are not needed. Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens would be considered.

Keywords: Nutrition, rickets, stoss therapy, steroid, over-the-counter drugs