Hypercalcemia and human nature

Patients on hemodialysis may develop severe and symptomatic hypercalcemia i f skeletal buffering is ineffective. We report a case of persistent hyperca lcemia with apparent extrarenal vitamin D synthesis. Associated aluminium i ntoxication was suggested on desferrioxamine challenge and adynamic uremic osteodystrophy confirmed on bone biopsy. Plasma calcitriol did not suppress with corticosteroids but did with ketoconazole. No other evidence for unde rlying granulomatous disease was found. We discuss our approach to less usu al causes of hypercalcemia, and emphasise the pitfalls associated with fact itious disorders.