Anne Sophie Koldkjær Sølling1, Birgitte G Tougaard2, Torben Harsløf3, Bente Langdahl3, Helle Kongsbak Brockstedt3, Keld-Erik Byg4, Per Ivarsen5, Ina Karstoft Ystrøm5, Frank Holden Mose6, Gustaf Lissel Isaksson2, Morten Steen Svarer Hansen2,7, Subagini Nagarajah2,8, Charlotte Ejersted7, Elisabeth Bendstrup9, Lars Rejnmark3. 1. Department of Endocrinology and Internal MedicineTHG, Aarhus University Hospital, Aarhus, Denmark annesoel@rm.dk. 2. Department of Nephrology and Internal MedicineRegional Hospital Kolding, Kolding, Denmark. 3. Department of Endocrinology and Internal MedicineTHG, Aarhus University Hospital, Aarhus, Denmark. 4. Department of RheumatologyOdense University Hospital, Odense, Denmark. 5. Department of NephrologyAarhus University Hospital, Aarhus, Denmark. 6. University Clinic in Nephrology and HypertensionRegional Hospital West Jutland and Aarhus University, Holstebro, Denmark. 7. Department of EndocrinologyOdense University Hospital, Odense, Denmark. 8. Department of Cardiovascular and Renal ResearchInstitute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. 9. Department of Respiratory Diseases and AllergyAarhus University Hospital, Aarhus, Denmark.
Abstract
INTRODUCTION: Injection of paraffin oil to augment muscles size is a troubling phenomenon known to cause a foreign body reaction with formation of granulomas. In a few case reports, long-term side effects have been reported in terms of hypercalcemia and renal failure. METHODS: We identified a case series of 12 male bodybuilders presenting with non-parathyroid hypercalcemia who previously had injected paraffin oil to increase muscles size. RESULTS: At admission, all patients had moderate-to-severe hypercalcemia with suppressed PTH levels and impaired renal function. Calcitriol levels were within the normal range or slightly elevated. Follow-up measurements showed marked hypercalciuria with nearly normal levels of bone turnover markers. A correlation was found between levels of peptidyl dipeptidase and calcitriol (R = 0.812, P = 0.050). Treatment with antiresorptive agents seemed less effective than glucocorticoids, which resulted in a significantly lowering of ionized calcium levels and improved renal function, although no patients were cured by this treatment. Immunosuppression with azathioprine or mycophenolate may have a glucocorticoid-saving effect. One patient had surgery with removal of affected muscle tissue, without any apparent effect on plasma calcium levels. CONCLUSION: The hypercalcemia and associated hypercalciuria seems to be due to an intestinal hyperabsorption of calcium. It remains to be elucidated, whether an increased calcitriol synthesis within granulomas is the only (main) mechanism by which intestinal calcium absorption is increased. Glucocorticoids seem most appropriate as the first choice for treatment. Bodybuilders should be warned against use of intramuscular oil injections (and other substances), as this may have severe adverse health consequences.
INTRODUCTION: Injection of paraffin oil to augment muscles size is a troubling phenomenon known to cause a foreign body reaction with formation of granulomas. In a few case reports, long-term side effects have been reported in terms of hypercalcemia and renal failure. METHODS: We identified a case series of 12 male bodybuilders presenting with non-parathyroid hypercalcemia who previously had injected paraffin oil to increase muscles size. RESULTS: At admission, all patients had moderate-to-severe hypercalcemia with suppressed PTH levels and impaired renal function. Calcitriol levels were within the normal range or slightly elevated. Follow-up measurements showed marked hypercalciuria with nearly normal levels of bone turnover markers. A correlation was found between levels of peptidyl dipeptidase and calcitriol (R = 0.812, P = 0.050). Treatment with antiresorptive agents seemed less effective than glucocorticoids, which resulted in a significantly lowering of ionizedcalcium levels and improved renal function, although no patients were cured by this treatment. Immunosuppression with azathioprine or mycophenolate may have a glucocorticoid-saving effect. One patient had surgery with removal of affected muscle tissue, without any apparent effect on plasma calcium levels. CONCLUSION: The hypercalcemia and associated hypercalciuria seems to be due to an intestinal hyperabsorption of calcium. It remains to be elucidated, whether an increased calcitriol synthesis within granulomas is the only (main) mechanism by which intestinal calcium absorption is increased. Glucocorticoids seem most appropriate as the first choice for treatment. Bodybuilders should be warned against use of intramuscular oil injections (and other substances), as this may have severe adverse health consequences.
Authors: Julie de Bellefroid; Stefaan Vandecasteele; Sebastiaan Van Cauwenberge; Roger Bouillon; Annick Van den Bruel Journal: J Endocr Soc Date: 2019-08-27