Endocrine Abstracts

Background: Hypercalcaemia has a broad differential diagnosis, including malignancy, primary hyperparathyroidism, and granulomatous diseases. Silicone-induced granulomatous disease is a rare cause of hypercalcaemia that poses diagnostic challenges. This report highlights a case of hypercalcaemia secondary to silicone granulomas following cosmetic injections.

Case Presentation: A 41-year-old lady was admitted with severe sepsis, acute kidney injury, and left pyelonephritis complicated by multiple renal stones. During her admission, persistent hypercalcaemia was identified. Her history included cosmetic gluteal silicone injections performed ten years earlier in Brazil and prolonged use of anabolic steroids. There was no history of malignancy, sarcoidosis, or autoimmune disease. Laboratory tests showed suppressed parathyroid hormone (PTH), normal PTH-related peptide (PTHrP), elevated serum angiotensin-converting enzyme (ACE) at 117 U/l, and calcitriol at the upper limit of normal (124 pmol/l). Vitamin D was 77 pmol/l. Urinary calcium was elevated, with worsening renal function. Vitamin A levels were high. Serum electrophoresis revealed mildly increased kappa and lambda light chains with a normal ratio. Imaging excluded malignancy or sarcoidosis. CT scan showed bilateral gluteal fat stranding and fat-density lesions consistent with silicone injections, while PET scan confirmed bilateral silicone deposits without neoplastic activity. A diagnosis of silicone-induced granulomatous disease causing calcitriol-mediated hypercalcemia was made.

Management and Outcome: Hypercalcemia was resistant to intravenous fluids and bisphosphonates. Oral prednisolone (40 mg daily) was initiated, leading to a rapid decline in serum calcium. Multidisciplinary input from endocrinology, nephrology, plastic surgery and radiology guided management. The patient’s calcium remains mildly elevated on steroids, requiring ongoing monitoring.

Conclusion: Silicone granulomas are a rare cause of non-PTH-mediated hypercalcemia. A history of cosmetic silicone injections combined with elevated ACE and calcitriol should prompt consideration of this diagnosis. Corticosteroids are the primary treatment, with bisphosphonates and surgery reserved for refractory cases.