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

• Main Authors: 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
• Format: Article
• Language: English
• Published: Galenos Yayincilik 2019-06-01
• Series: JCRPE
• Subjects: Nutrition; rickets; stoss therapy; steroid; over-the-counter drugs
• Online Access: http://www.jcrpe.org/archives/archive-detail/article-preview/comparison-of-treatment-regimens-in-management-of-/19904
• ISSN: 1308-5727; 1308-5735

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.