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Elisabeth Bendstrup

Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders

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DOI

  • Anne Sophie Koldkjær Sølling
  • Birgitte Tougaard, B Tougaard, Department of Nephrology and Internal Medicine, Regional Hospital Kolding, Kolding, Denmark.
  • ,
  • Torben Harsløf
  • Bente Langdahl
  • Helle Kongsbak Brockstedt
  • ,
  • Keld-Erik Byg, K Byg, Department of Rheumatology, Odense University Hospital, Odense , Denmark.
  • ,
  • Per Ivarsen
  • Ina Karstoft Ystrøm, I Karstoft Ystrøm, Department of Nephrology, Aarhus University Hospital, Aarhus , Denmark.
  • ,
  • Frank Holden Mose
  • Gustaf Lissel Isaksson, G Lissel Isaksson, Department of Nephrology and Internal Medicine, Regional Hospital Kolding, Kolding , United Kingdom of Great Britain and Northern Ireland.
  • ,
  • Morten Steen Svarer Hansen, M Steen Svarer Hansen , Department of Nephrology and Internal Medicine, Department of Endocrinology, Regional Hospital Kolding and Odense University Hospital, Kolding and Odense, Denmark.
  • ,
  • Subagini Nagarajah, S Nagarajah, Department of Nephrology and Internal Medicine, Regional Hospital Kolding, Kolding , Denmark.
  • ,
  • Charlotte Ejersted, C Ejersted, Department of Endocrinology, Odense University Hospital, Odense , Denmark.
  • ,
  • Elisabeth Bendstrup
  • Lars Rejnmark

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.

Original languageEnglish
JournalEuropean Journal of Endocrinology
Volume198
Issue6
Pages (from-to)29-37
Number of pages9
ISSN0804-4643
DOIs
Publication statusPublished - 2018

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