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Abstract: SA-PO692

Injection of Silicone for Cosmetic Gluteal Augmentation Leading to Hypercalcemia

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Kamarzarian, Anita, UCLA Medical Center Olive View, Sylmar, California, United States
  • Haghi, Masoud, UCLA Medical Center Olive View, Sylmar, California, United States
  • Pham, Phuong-Chi T., UCLA Medical Center Olive View, Sylmar, California, United States
  • Jafari, Golriz, UCLA Medical Center Olive View, Sylmar, California, United States
Introduction

Hypercalcemia can be seen in many common Granulomatous disease such as Sarcoidosis,Tuberculosis, and Granulomatosis with Polyangiitis (PTH- indipendent). Silicon injection for cosmetic procedures have also been associated with granuloma formations and subsequent hypercalcemia.

Case Description

58 yo Hispanic female presents for evaluation of chronic non-healing bilateral gluteal wounds. She has a history of CKD stage 3, nephrolilithiasis, and chronic hypercalcemia not previously worked up. She also has a history of Silicon injections into bilateral Gluteal regions in Mexico for cosmetic pursposes 25 years ago.
LABS:
Sodium-136 mmol/L, Potassium-5.0 mmol/L, Chloride-104 mmol/L, CO2-22 mmol/L, BUN-62 mg/dL, Creatinine-2.21 mg/dL, Calcium-11.0 mg/dL, Corrected Calcium-12.92mg/dL, Albumin-1.6 g/dL, Phosphorus-3.6 mg/dL, Magnesium-2.1 mg/dL, SPEP/UPEP Normal, TSH-1.665 uIU/mL, PTH<2 pg/ml, PTH-RP-16 pg/ml (WNL), Vitamin D 25-OH 12ng/ml, Vitamin D2 1,25-OH 8 pg/ml, Vitamin D3 1,25-OH 60pg/ml, Urine 24H Calcium 283.8 mg/24 HR, Alk Phos 246 U/L.

Discussion

Investigation revealed depressed PTH, Low vitamin D25 level and elevated Vitamin D2-1,25 level. Imaging including CT and PET showed evidence of significant long standing calcified granulomas. Patient also had biopsy of the gluteal wounds which showed foci of foreign body-type multinucleated giant cell reaction and extensive calcifications. Normally conversion of Vitamin D 25-OH to Vitamin D2 1,25 OH occurs in the kidney via a 1-hydroxylase enzyme that is under the physiologic control of PTH, FGF-23, and the serum phosphourus level . In granulomatous diseases, this conversion is occurring independent of these controls inside giant cells. The high levels of converted Vitamin D2 1,25-OH causes increased intestinal calcium absorption and increased bone resorption leading to hypercalcemia.

CT of Abdomen showing extensive soft issue calcified granulomas in gluteal tisssue