Letters to the Editor

Additional Causes of Hypercalcemia in Infants



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Am Fam Physician. 2004 Jun 15;69(12):2766.

to the editor: I read with interest the article, “A Practical Approach to Hypercalcemia,”1 in the May 1, 2003, issue of American Family Physician. In addition to the causes of hypercalcemia that were listed in the article, family physicians who take care of infants also may want to consider other etiologies (see accompanying table).2

I also would be interested to know whether the authors think that substituting a spot urine calcium/creatinine ratio for a 24-hour urine calcium level is acceptable for evaluation of these infants. Timed urine collections can be difficult, especially in children.

Hypercalcemia in Infants

Williams syndrome

Autosomal recessive hypophosphatasia

Secondary hyperparathyroidism from maternal hypocalcemia

Blue diaper syndrome

Jansen metaphyseal chondrodysplasia

Subcutaneous fat necrosis

Dietary phosphate deficiency

Hypercalcemia in Infants

View Table

Hypercalcemia in Infants

Williams syndrome

Autosomal recessive hypophosphatasia

Secondary hyperparathyroidism from maternal hypocalcemia

Blue diaper syndrome

Jansen metaphyseal chondrodysplasia

Subcutaneous fat necrosis

Dietary phosphate deficiency

REFERENCES

1. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67:1959–66.

2. Claudius IA, Fattal O, Nakamoto J. Hypercalcemia. Accessed March 9, 2004 at: http://www.emedicine.com/ped/topic1062.htm.

in reply: In infants, hypercalcemia is a rare but serious condition which should be investigated and treated without delay. The most common causes are iatrogenic administration of calcium (generally intravenously) and idiopathic infantile hypercalcemia, of which Williams syndrome is the severe variant.1 Severe primary hyperparathyroidism and homozygous familial hypocalciuric hypercalcemia presenting in the neonatal period may require rapid surgical intervention. As with adults, if hypercalcemia is confirmed with an elevated ionized calcium level, the measurement of intact parathyroid hormone level is the pivotal step in evaluation of the causative disorder. Calculation of a calcium/creatinine ratio using a random spot urine specimen correlates well with total 24-hour urinary calcium excretion.2 In the diagnostic algorithm for hypercalcemia, the urinary calcium/creatinine ratio can be used as a convenient and accurate substitution for a timed urine collection in term and preterm infants.3

REFERENCES

1. Rodd C, Goodyear P. Hypercalcemia of the newborn: etiology, evaluation, and management. Pediatr Nephrol. 1999;13:542–7.

2. Gokce C, Gokce O, Baydinc C, Ilhan N, Alasehirli E, Ozkucuk F, et al. Use of random urine samples to estimate total urinary calcium and phosphate excretion. Arch Intern Med. 1991;151:1587–8.

3. Trotter A, Stoll M, Leititis JU, Blatter A, Pohlandt F. Circadian variations of urinary electrolyte concentrations in preterm and term infants. J Pediatr. 1996;128:253–6.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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