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

Anne Sophie Sølling; Birgitte Tougaard; Torben Harsløf; Bente Langdahl; Helle Kongsbak Brockstedt; Keld-Erik Byg; Per Ivarsen; Ina Karstoft Ystrøm; Frank Holden Mose; Gustaf Lissel Isaksson; Morten Steen Svarer Hansen; Subagini Nagarajah; Charlotte Ejersted; Elisabeth Bendstrup; Lars Rejnmark

doi:10.1530/EJE-18-0051

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

Anne Sophie Sølling, Birgitte Tougaard, Torben Harsløf, Bente Langdahl, Helle Kongsbak Brockstedt, Keld-Erik Byg, Per Ivarsen, Ina Karstoft Ystrøm, Frank Holden Mose, Gustaf Lissel Isaksson, Morten Steen Svarer Hansen, Subagini Nagarajah, Charlotte Ejersted, Elisabeth Bendstrup, Lars Rejnmark

Department of Clinical Medicine - Department of Endocrinology and Internal Medicine
Department of Clinical Medicine - Department of Medicine and Nephrology
Department of Clinical Medicine - University Clinic in Nephrology and Hypertension, Holstebro Hospital
Department of Clinical Medicine - Department of Respiratory Diseases and Allergy

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

17 Citations (Scopus)

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.

Original language	English
Journal	European Journal of Endocrinology
Volume	198
Issue	6
Pages (from-to)	29-37
Number of pages	9
ISSN	0804-4643
DOIs	https://doi.org/10.1530/EJE-18-0051
Publication status	Published - Jun 2018

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Sølling, A. S., Tougaard, B., Harsløf, T., Langdahl, B., Kongsbak Brockstedt, H., Byg, K.-E., Ivarsen, P., Karstoft Ystrøm, I., Holden Mose, F., Lissel Isaksson, G., Steen Svarer Hansen, M., Nagarajah, S., Ejersted, C., Bendstrup, E., & Rejnmark, L. (2018). Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders. European Journal of Endocrinology, 198(6), 29-37. https://doi.org/10.1530/EJE-18-0051

@article{e61fd1b4a5ab4078a6d8a36121140246,

title = "Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders",

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.",

author = "S{\o}lling, {Anne Sophie} and Birgitte Tougaard and Torben Harsl{\o}f and Bente Langdahl and {Kongsbak Brockstedt}, Helle and Keld-Erik Byg and Per Ivarsen and {Karstoft Ystr{\o}m}, Ina and {Holden Mose}, Frank and {Lissel Isaksson}, Gustaf and {Steen Svarer Hansen}, Morten and Subagini Nagarajah and Charlotte Ejersted and Elisabeth Bendstrup and Lars Rejnmark",

year = "2018",

month = jun,

doi = "10.1530/EJE-18-0051",

language = "English",

volume = "198",

pages = "29--37",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "Oxford University Press",

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Sølling, AS, Tougaard, B, Harsløf, T , Langdahl, B, Kongsbak Brockstedt, H, Byg, K-E, Ivarsen, P, Karstoft Ystrøm, I, Holden Mose, F, Lissel Isaksson, G, Steen Svarer Hansen, M, Nagarajah, S, Ejersted, C, Bendstrup, E & Rejnmark, L 2018, 'Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders', European Journal of Endocrinology, vol. 198, no. 6, pp. 29-37. https://doi.org/10.1530/EJE-18-0051

Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders. / Sølling, Anne Sophie; Tougaard, Birgitte; Harsløf, Torben et al.
In: European Journal of Endocrinology, Vol. 198, No. 6, 06.2018, p. 29-37.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Non-parathyroid hypercalcemia associated with paraffin oil injection in 12 younger male bodybuilders

AU - Sølling, Anne Sophie

AU - Tougaard, Birgitte

AU - Harsløf, Torben

AU - Langdahl, Bente

AU - Kongsbak Brockstedt, Helle

AU - Byg, Keld-Erik

AU - Ivarsen, Per

AU - Karstoft Ystrøm, Ina

AU - Holden Mose, Frank

AU - Lissel Isaksson, Gustaf

AU - Steen Svarer Hansen, Morten

AU - Nagarajah, Subagini

AU - Ejersted, Charlotte

AU - Bendstrup, Elisabeth

AU - Rejnmark, Lars

PY - 2018/6

Y1 - 2018/6

N2 - 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.

AB - 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.

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U2 - 10.1530/EJE-18-0051

DO - 10.1530/EJE-18-0051

M3 - Journal article

C2 - 29599408

SN - 0804-4643

VL - 198

SP - 29

EP - 37

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 6

ER -

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

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