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Hypercalcemia Associated with Increased Serum Calcitriol Levels in Three Patients with Lymphoma

[+] Article and Author Information

Grant support: in part by the U. S. Public Health Service Training Grant 1-T32AM07307; Grants AM26253, AM16061, CA23115, and CA18132 from the National Institutes of Health; General Clinical Research Center Grant MO1-RR00633; Program Project Grant AM20543; the Meadows Foundation; and the Southwestern Medical Foundation-Kinsler Williamson Brown Fund.

Presented in part in April 1982 at the annual meeting of the American Society of Clinical Investigation; Washington D.C.

▸Requests for reprints should be addressed to Neil A. Breslau, M.D.; Department of Internal Medicine, University of Texas Health Science Center at Dallas, Southwestern Medical School, 5323 Harry Hines Boulevard; Dallas, TX 75235.

Dallas, Texas

© 1984 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1984;100(1):1-7. doi:10.7326/0003-4819-100-1-1
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A radioreceptor assay for serum 1,25-dihydroxyvitamin D (calcitriol) was used to screen patients with hypercalcemia of malignancy. Three patients with non-Hodgkin's lymphoma and hypercalcemia (serum Ca, 12.0, 13.4, and 13.0 mg/dL, respectively) had increased serum calcitriol levels (56, 72, and 77 pg/mL, respectively; normal, < 50 pg/mL). Elevated levels of calcitriol, an active vitamin D metabolite, occurred in the presence of significant renal impairment (creatinine clearance, 8 to 19 mL/min) and relative parathyroid suppression (serum immunoreactive parathyroid hormone, 17 to 39 µL-eq/ mL; mean value in end-stage renal disease, 182 ± 39 µLeq/mL). Hypercalcemia and excessive serum calcitriol levels responded to glucocorticosteroid therapy. In two patients, the hypercalcemia and increased serum calcitriol level were related to a tumor, but not to the serum immunoreactive parathyroid hormone level. Fractional intestinal 47Ca absorption, measured in one patient, was increased (0.94; normal, < 0.61) and varied directly with the serum calcitriol level. No patient had evidence of sarcoidosis. Hypercalcemia associated with certain lymphomas may be caused by the increased synthesis of calcitriol by lymphoma cells.





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