Hypercalcemia in mycobacterial infection

Abstract

Ten patients with tuberculosis and hypercalcemia were subjected to detailed clinical study after ascertaining that other known causes of hypercalcemia were absent. Normocalcemia was present on hospital admission in eight of the ten patients with the development of hypercalcemia two to sixteen weeks after admission. Six patients had known intakes of vitamin D2 of 400 to 3000 USP units daily for two to 22 weeks of hospitalization, exclusive of food and other dietary supplements. Steroid suppression tests were performed in six patients and were positive. In nine patients, the serum calcium became normal, exclusive of the immediate effect of the steroid suppression test, when vitamin D2 and calcium supplements were deleted and the underlying tuberculosis was treated. Normal serum inorganic phosphorus, normal alkaline phosphatase activity and a normal renal tubular reabsorption of phosphorus were usually present. Hypercalciuria was observed in four of six patients in which the measurement was made. These data suggest that hypercalcemia occurring i n the course of tuberculous infection may be due o t an abnormal sensitivity to vitamin D similar to that observed in sarcoidosis. Since renal impairment, mental symptoms and other deleterious consequences of hypercalcemia may ensue, the administration of vitamin and calcium supplements o t tuberculous patients should be carefully controlled. © 1972 by The Endocrine Society.