TY  - BOOK
AU  - Antoni, Fidini
AU  - Haas, Christopher
AU  - Madsen-Barbosa, Thayse L
AU  - Martinez-Cruz, Maria
TI  - Endocrine Shades of Silicone Fillers: A Case of Calcitriol-mediated Hypercalcemia
SN  - 2000-9666
PY  - 2024///
KW  - Automated
KW  - MedStar Union Memorial Hospital
KW  - Hospitalist
KW  - Internal Medicine Residency
KW  - Case Reports
KW  - Journal Article
N2  - Background: The inflammatory reaction of foreign body granulomas (FBG) may be so vast that it leads to severe systemic effects; Case report: A 42-year-old woman was referred to the ED with severe recurrent symptomatic hypercalcemia associated with worsening kidney function. She had presented multiple times with similar complaints. Severe hypercalcemia (13.8 mg/dL) was noted, with appropriately low PTH, elevated PTHrP, low 25-hydroxyvitamin D, and normal 1,25-dihydroxyvitamin D levels. She admitted having significant subcutaneous silicone filler injections in the hips six years prior. Admission workup revealed a normal 25-hydroxyvitamin D, but a marked elevation of 1,25-dihydroxyvitamin D (138 pg/mL). Whole-body PET-CT demonstrated moderate 2-18F-fluoro-2-deoxy-d-glucose (FDG) uptake within the subcutaneous adipose tissue of the lateral aspects of the gluteal regions. She was diagnosed with silicone filler injection-induced hypercalcemia, secondary to granulomatous inflammation. Her calcium level normalized a month after the initiation of prednisone; Conclusion: Granulomatous inflammation from silicone filler injection can cause hypercalcemia by uncontrolled production of calcitriol and increased PTHrP production by macrophages and giant cells. Copyright © 2024 Greater Baltimore Medical Center; Discussion: FBG may occur years after filler injection. In rare cases, a significant granulomatous immune response leads to uncontrolled production of calcitriol. Pro-inflammatory cytokines can also upregulate PTHrP expression in macrophages, further contributing to hypercalcemia. Treatment focuses on general hypercalcemia management and FBG remission, most effectively achieved with anti-inflammatory corticosteroid doses. Nevertheless, further studies are needed to evaluate its long-term treatment efficacy
UR  - https://dx.doi.org/10.55729/2000-9666.1349
ER  -