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Abstract: SA-PO512

Man of Steel: Calcitriol-Mediated Hypercalcemia From Subcutaneous Injection of Vitamin D3 in Sesame Oil

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical


  • Chadha, Anushka, Jackson Memorial Hospital, Miami, Florida, United States
  • Chavez, Efren, University of Miami School of Medicine, Miami, Florida, United States

Parathyroid hormone (PTH) independent hypercalcemia in young patients is rare. Differential diagnosis include malignancy, granulomatous diseases, adrenal insufficiency and drug-induced hypercalcemia.
We report a case of a young athlete who developed calcitriol-mediated hypercalcemia due to granulomatous disease from oil-based subcutaneous (SQ) injections.

Case Description

A 31 year-old male, professional Jiu-jitsu player with no prior history, presented to the ED with worsening nausea, headaches, night sweats and weight loss over several weeks. He just completed a 3 month physician-supervised body building program, taking multiple drugs to increase strength and muscle mass- including daily oral danazol 100 mg, anastrozole 1 mg, DHEA 100 mg, clomiphene citrate 50 mg, bi-weekly intramuscular HCG 10,000 IU and weekly SQ injections of vitamin D3 in sesame oil 100,000 units/mL. On admission, vital signs were stable. Labs with elevated corrected calcium 12.4 mg/dL, ionized calcium 1.97 mmol/L, and acute kidney injury (AKI) with creatinine 4.2 mg/dL (baseline creatinine 0.95 mg/dL). He was initially treated with normal saline, calcitonin and zoledronic acid 3 mcg infusion. On further work up, he had low intact PTH 5.58 pg/mL, undetectable PTH related peptide but elevated 1,25 (OH)2 Vitamin D 146 pg/mL. Screening for sarcoidosis, tuberculosis and fungal infections was negative. Imaging did not show masses, lymphadenopathy or organomegaly. However, a whole body FDG PET/CT scan had hypermetabolic uptake with skin thickening in the right thigh and anterior pelvic wall, corresponding to areas of administered SQ Vitamin D3. He was treated with oral prednisone, achieving and sustaining resolution of hypercalcemia and AKI.


Hypercalcemia with suppressed PTH has been attributed to use of cosmetic body fillers- silicone and methyl methacrylate injections. Bodybuilders and athletes similarly use oil-based injections to augment muscle size. Biopsies from those areas demonstrate a foreign body reaction with granuloma formation and express 1α-hydroxylase activity; this suggests hypercalcemia is due to increased calcitriol synthesis and intestinal calcium absorption. Our case demonstrates the dangers of abusing improper medications for body building and how providers should be vigilant to identify use of oil-based injections and its association with hypercalcemia