Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder
| Autor: | Lakdasa Premawardhana, Mohamed Adlan, Suhani Bahl, Ravikumar Ravindran, Justyna Witczak |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Hypercalcaemia Ejection fraction Ventricular hypertrophy Focal segmental glomerulosclerosis Endocrinology Diabetes and Metabolism Echocardiogram Pamidronate White lcsh:Diseases of the endocrine glands. Clinical endocrinology Gastroenterology Ultrasound scan Rhabdomyolysis chemistry.chemical_compound 0302 clinical medicine Furosemide Testosterone CD-45 FT4 Estimated glomerular filtration rate Vitamin D Myositis Bisoprolol Urea and electrolytes biology TSH Calcimimetics Acute kidney injury Bisphosphonates Hypervitaminosis GH Proteinuria Nephrology July 030220 oncology & carcinogenesis Creatinine Phosphate (serum) Steroids Cinacalcet Renal biopsy Calcium (serum) PTH MRI Muscle biopsy Adult medicine.medical_specialty Kidney stones Prednisolone Thyroxine (T4) Histopathology 030209 endocrinology & metabolism 03 medical and health sciences Internal medicine Fluid repletion Glomerulosclerosis Internal Medicine medicine Vitamin A Mycophenolate Hypervitaminosis A Creatine kinase Bone Glucocorticoids Enlarged prostate Aortic stenosis lcsh:RC648-665 business.industry Albumin CD-3 Hyperparathyroidism (primary) Tamulosin medicine.disease Unique/Unexpected Symptoms or Presentations of a Disease United Kingdom Oedema Myocardial infarction chemistry 25-hydroxyvitamin-D3 biology.protein Lansoprazole business Constipation Calcification |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-5 (2020) |
| ISSN: | 2052-0573 |
| Popis: | Summary A 53-year-old man who used growth hormone (GH), anabolic steroids and testosterone (T) for over 20 years presented with severe constipation and hypercalcaemia. He had benign prostatic hyperplasia and renal stones but no significant family history. Investigations showed – (1) corrected calcium (reference range) 3.66 mmol/L (2.2–2.6), phosphate 1.39 mmol/L (0.80–1.50), and PTH 2 pmol/L (1.6–7.2); (2) urea 21.9 mmol/L (2.5–7.8), creatinine 319 mmol/L (58–110), eGFR 18 mL/min (>90), and urine analysis (protein 4+, glucose 4+, red cells 2+); (3) creatine kinase 7952 U/L (40–320), positive anti Jo-1, and Ro-52 antibodies; (4) vitamin D 46 nmol/L (30–50), vitamin D3 29 pmol/L (55–139), vitamin A 4.65 mmol/L (1.10–2.60), and normal protein electrophoresis; (5) normal CT thorax, abdomen and pelvis and MRI of muscles showed ‘inflammation’, myositis and calcification; (6) biopsy of thigh muscles showed active myositis, chronic myopathic changes and mineral deposition and of the kidneys showed positive CD3 and CD45, focal segmental glomerulosclerosis and hypercalcaemic tubular changes; and (7) echocardiography showed left ventricular hypertrophy (likely medications and myositis contributing), aortic stenosis and an ejection fraction of 44%, and MRI confirmed these with possible right coronary artery disease. Hypercalcaemia was possibly multifactorial – (1) calcium release following myositis, rhabdomyolysis and acute kidney injury; (2) possible primary hyperparathyroidism (a low but detectable PTH); and (3) hypervitaminosis A. He was hydrated and given pamidronate, mycophenolate and prednisolone. Following initial biochemical and clinical improvement, he had multiple subsequent admissions for hypercalcaemia and renal deterioration. He continued taking GH and T despite counselling but died suddenly of a myocardial infarction. Learning points: The differential diagnosis of hypercalcaemia is sometimes a challenge. Diagnosis may require multidisciplinary expertise and multiple and invasive investigations. There may be several disparate causes for hypercalcaemia, although one usually predominates. Maintaining ‘body image’ even with the use of harmful drugs may be an overpowering emotion despite counselling about their dangers. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|