Tuberculosis hypercalcemia with

Measurement of 1,25 (OH) 2D is usefiil in detecting inadequate or excessive hormone production in the evaluation of hypercalcemia, hypercalciuria, hypocalcemia, and bone and mineral disorders (Box 49-10). Because activated macrophages convert 25(OH)D to l,25(OH)2D, serum concentrations of 1,25(OH)2D are often increased in sarcoidosis, tuberculosis, other granulomatous diseases. Rarely is lymphoma associated with increased concentrations of 1,25(0H)2D. Concentrations of l,25(OH)2D are elevated in vitamin D-dependent rickets type II and in l,25(OH)2D intoxication, and may be elevated in primary hyperparathyroidism. Fatients with primary hyperparathyroidism and... 

An exception seems to be the hypercalcemia that occurs in some patients with chronic granulomatous diseases, such as tuberculosis, sarcoidosis, and silicosis. The observed increase in circulating l,25-(OH)2D is presumably due to the increased 25-(OH)D-la -hydroxylase activity found in the inflammatory cells in the granulomas. The hydroxylase activity does not appear to be under the usual tight feedback control by serum calcium levels. 

Hypercalcemia was also reported in an HIV-infected patient with disseminated tuberculosis who was being supplemented with Vitamin D [80 ]. Secondary pseudogout due to vitamin D supplementation was also reported in another case [81 ]. 

Lescoat A, Poinsignon Y, Dos Santos A, Cano Y, Hoc h F, Jardel H. Vitamin D supplementation a iatrogenic hypercalcemia concerning an HIV-infected patient with disseminated tuberculosis [Article in French]. Presse Med December 2012 41(12 Pt 1) 1299-301. 

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