ESPE Abstracts (2015) 84 P-3-642

Comparison of Treatment Alternatives for Hypercalcemia due to Vitamin D Intoxication in Children

Korcan Demira,l, Hakan Dönerayb, Ediz Yesilkayac, Cengiz Karad, Zeynep Ataye, Semra Çetinkayaf, Atilla Çayirg, Ahmet Anika, Erdal Erenh, Fatma Demireli, Gülay Can Yilmazd, Ayca Torel Ergurj, Mustafa Kendircik, Zehra Aycanf, Abdullah Berekete, Murat Aydind, Zerrin Orbakb & Behzat Özkanl


aDivision of Pediatric Endocrinology, Dokuz Eylül University, Izmir, Turkey; bDivision of Pediatric Endocrinology, Atatürk University, Erzurum, Turkey; cDivision of Pediatric Endocrinology, Gülhane Military Medical Academy, Ankara, Turkey; dDivision of Pediatric Endocrinology, On Dokuz Mayis University, Samsun, Turkey; eDivision of Pediatric Endocrinology, Marmara University, Istanbul, Turkey; fDivision of Pediatric Endocrinology, Sami Ulus Children’s Hospital, Ankara, Turkey; gDivision of Pediatric Endocrinology, Erzurum State Research and Training Hospital, Erzurum, Turkey; hDivision of Pediatric Endocrinology, Uludag University, Bursa, Turkey; iDivision of Pediatric Endocrinology, Children’s Hematology and Oncology Research and Training Hospital, Ankara, Turkey; jDivision of Pediatric Endocrinology, Kirikkale University, Kirikkale, Turkey; kDivision of Pediatric Endocrinology, Erciyes University, Kayseri, Turkey; lDivision of Pediatric Endocrinology, Dr Behçet Uz Children’s Hospital, Izmir, Turkey


Background: No large study comparing efficiency of prednisolone, alendronate and pamidronate has been conducted so far in children with hypercalcemia due to vitamin D intoxication.

Objective and hypotheses: To perform a multicentre, retrospective study assessing clinical characteristics and treatment results.

Method: A standard questionnaire was uploaded to an online national database system (www.favorsci.org) to collect data of children with hypercalcemia (serum calcium, >10.5 mg/dl) due to vitamin D intoxication (serum vitamin D, >150 ng/ml) who were treated in paediatric endocrinology clinics.

Results: 74 children (mean age 1.4±1.3 years, 45 males (60.8%)) from 11 canters were included. High doses of vitamin D intake was obvious in 77% of the cases. At diagnosis, mean calcium, vitamin D, and PTH levels were 15±3.2 mg/dl, 400±290 ng/ml, and 7.9±7.8 pg/ml respectively. Calcium levels showed only mild correlation with vitamin D levels (r=0.332, P=0.004). Patients were designated into five groups according to the initial treatment regimens (See Table). During follow-up, pamidronate and calcitonin treatments were also given in three and four cases, respectively, in group 2. Initial median calcium levels were similar (P=0.244) among groups 2, 3, and 4 allowing comparison for treatment efficiency. The time to achieve normocalcaemia was comparable (P=0.099) among groups 2, 3, and 4. However, recurrence rate of hypercalcemia was significantly lower in group 4 compared to groups 2 and 3 (0 (0%), 2 (25%), and 3 (30%) respectively, P=0.02).

Conclusion: In mild cases, hydration and furosemide are sufficient. For moderate cases, some of the patients given prednisolone require additional interventions (namely, pamidronate and calcitonin) to restore normocalcaemia. Pamidronate use is associated with a similar time to achieve normocalcaemia but with a lower recurrence rate. In severe hypercalcemia, physicians tended to start combination of treatments thus no comparison could be done with this group.

Funding: This work was supported by a grant from the Pediatric Endocrinology and Diabetes Society, Turkey (2014-000522).