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Giuseppe Saggese, MD; Silvano Bertelloni, MD; Giampiero I. Baroncelli, MD; Giovanna Di Nero, MD

Am J Dis Child. 1993;147(3):270-273.

Abstract
• Objective.
—To evaluate whether tuberculosis-associated hypercalcemia is related to abnormal synthesis of 1,25-dihydroxyvitamin D (1,25[OH]₂D) and whether ketoconazole administration may be useful in treating tuberculosis-associated hypercalcemia.

Design.
—Case study.

Setting.
—Endocrine Unit, Pediatric Clinic, University of Pisa (Italy).

Participants.
—Two boys (aged 10.5 years and 14.7 years) with active tuberculosis and hypercalcemia.

Measurements/Main Results.
—At admission, serum 1,25-dihydroxyvitamin D levels were elevated. Oral ketoconazole administration (3.0 mg/kg every 8 hours) decreased 1,25-dihydroxyvitamin D levels within the first week of therapy (from 208.8 to 57.6 pmol/L [–72.4%] in one boy and from 321.6 to 115.2 pmol/L [–64.2%] in the other). We also found a coincident normalization of serum ionized calcium concentration (from 1.45 to 1.24 mmol/L [–13.0%] in one boy and from 1.55 to 1.26 mmol/L [–17.0%] in the other).

Conclusions.
—Abnormal elevated levels of 1,25-dihydroxyvitamin D caused hypercalcemia in our patients; ketoconazole administration may be effective in the treatment of hypercalcemia in patients with tuberculosis, which decreases 1,25-dihydroxyvitamin D synthesis.

(AJDC. 1993;147:270-273)

Author Affiliations
From the Endocrine Unit, Department of Pediatrics, University of Pisa (Italy).

Footnotes
Accepted for publication August 21, 1992.

Presented in part at the Eighth Workshop on Vitamin D, Paris, France, July 7, 1991, and at the 30th Annual Meeting of the European Society for Pediatric Endocrinology, Berlin, Germany, August 27, 1992.

Reprint requests to the Head Chair of Preventive Pediatrics, Department of Pediatrics, University of Pisa, via Roma, 67, 1-56125 Pisa, Italy (Dr Saggese).

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