Hypercalcemia After Cosmetic Oil Injections: Unraveling Etiology, Pathogenesis, and Severity
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Hypercalcemia After Cosmetic Oil Injections: Unraveling Etiology, Pathogenesis, and Severity. / Eldrup, Ebbe; Theilade, Simone; Lorenzen, Mette; Andreassen, Christine H.; Poulsen, Katrine H.; Nielsen, John E.; Hansen, Ditte; El Fassi, Daniel; Berg, Jais O.; Bagi, Per; Jørgensen, Anne; Blomberg Jensen, Martin.
I: Journal of Bone and Mineral Research, Bind 36, Nr. 2, 2021, s. 322-333.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Hypercalcemia After Cosmetic Oil Injections: Unraveling Etiology, Pathogenesis, and Severity
AU - Eldrup, Ebbe
AU - Theilade, Simone
AU - Lorenzen, Mette
AU - Andreassen, Christine H.
AU - Poulsen, Katrine H.
AU - Nielsen, John E.
AU - Hansen, Ditte
AU - El Fassi, Daniel
AU - Berg, Jais O.
AU - Bagi, Per
AU - Jørgensen, Anne
AU - Blomberg Jensen, Martin
PY - 2021
Y1 - 2021
N2 - Intramuscular injections of paraffin oil can cause foreign body granuloma formation and hypercalcemia. Macrophages with the ability to produce high levels of 1,25(OH)2D3 may induce the mineral disturbance, but no major series of patients have been published to date. Here, medical history, physical evaluation, biochemical, and urinary analysis for calcium homeostasis were obtained from 88 males, who 6 years previously had injected paraffin or synthol oil into skeletal muscle. Moreover, granuloma tissue from three men was cultured for 48 hours ex vivo to determine 1,25(OH)2D3 production supported by qPCR and immunohistochemistry of vitamin D metabolism and immune cell populations after treatment with 14 different drugs. The 88 men were stratified into men with hypercalcemia (34%), whereas normocalcemic men were separated into men with either normal (42%) or suppressed parathyroid hormone (PTH) (24%). All men had high calcium excretion, and nephrolithiasis was found in 48% of hypercalcemic men, 22% of normocalcemic men with normal PTH, and 47% of normocalcemic men with suppressed PTH. Risk factors for developing hypercalcemia were oil volume injected, injection of heated oil, high serum interleukin‐2 receptor levels, and high urine calcium. High 1,25(OH)2D3/25OHD ratio, calcium excretion, and low PTH was associated with nephrolithiasis. The vitamin D activating enzyme CYP27B1 was markedly expressed in granuloma tissue, and 1,25(OH)2D3 was released in concentrations corresponding to 40% to 50% of the production by human kidney specimens. Dexamethasone, ketoconazole, and ciclosporin significantly suppressed granulomatous production of 1,25(OH)2D3. In conclusion, this study shows that injection of large oil volumes alters calcium homeostasis and increases the risk of nephrolithiasis. Hypercalciuria is an early sign of disease, and high granulomatous 1,25(OH)2D3 production is part of the cause. Prospective clinical trials are needed to determine if ciclosporin, ketoconazole, or other drugs can be used as prednisolone‐sparing treatment. © 2020 American Society for Bone and Mineral Research (ASBMR).
AB - Intramuscular injections of paraffin oil can cause foreign body granuloma formation and hypercalcemia. Macrophages with the ability to produce high levels of 1,25(OH)2D3 may induce the mineral disturbance, but no major series of patients have been published to date. Here, medical history, physical evaluation, biochemical, and urinary analysis for calcium homeostasis were obtained from 88 males, who 6 years previously had injected paraffin or synthol oil into skeletal muscle. Moreover, granuloma tissue from three men was cultured for 48 hours ex vivo to determine 1,25(OH)2D3 production supported by qPCR and immunohistochemistry of vitamin D metabolism and immune cell populations after treatment with 14 different drugs. The 88 men were stratified into men with hypercalcemia (34%), whereas normocalcemic men were separated into men with either normal (42%) or suppressed parathyroid hormone (PTH) (24%). All men had high calcium excretion, and nephrolithiasis was found in 48% of hypercalcemic men, 22% of normocalcemic men with normal PTH, and 47% of normocalcemic men with suppressed PTH. Risk factors for developing hypercalcemia were oil volume injected, injection of heated oil, high serum interleukin‐2 receptor levels, and high urine calcium. High 1,25(OH)2D3/25OHD ratio, calcium excretion, and low PTH was associated with nephrolithiasis. The vitamin D activating enzyme CYP27B1 was markedly expressed in granuloma tissue, and 1,25(OH)2D3 was released in concentrations corresponding to 40% to 50% of the production by human kidney specimens. Dexamethasone, ketoconazole, and ciclosporin significantly suppressed granulomatous production of 1,25(OH)2D3. In conclusion, this study shows that injection of large oil volumes alters calcium homeostasis and increases the risk of nephrolithiasis. Hypercalciuria is an early sign of disease, and high granulomatous 1,25(OH)2D3 production is part of the cause. Prospective clinical trials are needed to determine if ciclosporin, ketoconazole, or other drugs can be used as prednisolone‐sparing treatment. © 2020 American Society for Bone and Mineral Research (ASBMR).
KW - HYPERCALCEMIA
KW - COSMETIC OILS
KW - NEPHROLITHIASIS
U2 - 10.1002/jbmr.4179
DO - 10.1002/jbmr.4179
M3 - Journal article
C2 - 32931047
VL - 36
SP - 322
EP - 333
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
SN - 0884-0431
IS - 2
ER -
ID: 250604058