Hypercalcemia and vitamin A: A vitamin to keep in mind

Saif Munther Borgan; Leila Zeinab Khan; Vinni Makin

doi:10.3949/ccjm.89a.21056

ABSTRACT

Vitamin A, like many things in life, should be consumed in appropriate amounts. Excessive intake of preformed vitamin A, such as that found in supplements and animal sources (animal liver, fish liver oil, dairy, and eggs), is associated with multisystem effects that can include bone resorption and hypercalcemia. Hence, vitamin A toxicity should be explored in unexplained cases of parathyroid hormone-independent hypercalcemia. Serum retinol levels can be helpful in the diagnosis, but the results must be interpreted with caution since they do not always reflect total body levels. Treatment involves supportive care and withdrawal of vitamin A sources, especially preformed ones. Given the long half-life of retinol, normalization of serum levels can take several months.

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Saif Munther Borgan, MD

Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH

14357-leila-khanLeila Zeinab Khan, MD

Medical Director, Calcium and Parathyroid Center, Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic; Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

14431-vinni-makinVinni Makin, MD, FACE⇑

Director, East Region, Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic; Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH

Address:
Vinni Makin, MD, FACE, Department of Endocrinology, Diabetes, and Metabolism, F20, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; makinv{at}ccf.org