Comparison of Treatment Regimens in Management of Severe Hypercalcemia Due to Vitamin D Intoxication in Children
Korcan Demir1, Hakan Döneray2, Cengiz Kara3, Zeynep Atay4, Semra Çetinkaya5, Atilla Çayır6, Ahmet Anık7, Erdal Eren8, Ahmet Uçaktürk9, Gülay Can Yılmaz3, Ayça Törel Ergür10, Mustafa Kendirci11, Zehra Aycan5, Abdullah Bereket4, Murat Aydın3, Zerrin Orbak2, Behzat Özkan121Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey2Atatürk University Faculty of Medicine, Department of Children’s Health and Disease, Erzurum, Turkey
3Ondokuz Mayıs University Faculty of Medicine, Department of Children’s Health and Disease, Samsun, Turkey
4Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
5University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease, Health Implementation and Research Center, Ankara, Turkey
6Erzurum State Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
7Adnan Menderes University Faculty of Medicine, Department of Children’s Health and Disease, Aydın, Turkey
8Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
9Ankara Children’s Hematology and Oncology Training Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
10Kırıkkale University Faculty of Medicine, Department of Children’s Health and Disease, Kırıkkale, Turkey
11Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
12University of Health Sciences Dr. Behçet Uz Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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.
Manuscript Language: English
