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Ramos-Gallardo G, Cuenca-Pardo J, Cárdenas-Camarena L, Sánchez-Cervantes AL, González-Castañeda OJ. Morbidity induced by the infiltration of foreign substances into the buttocks: A systematic review. J Plast Reconstr Aesthet Surg 2024; 91:135-153. [PMID: 38412603 DOI: 10.1016/j.bjps.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
The infiltration of substances into the buttocks for esthetic purposes can cause local or systemic damage. These infiltrated substances, known as adjuvants, foreign substances, and polymers, often lack sufficient and frequently controversial evidence. To identify the systemic complications associated with substances locally infiltrated in the buttocks for treatment, we conducted a systematic review following the PRISMA criteria. Of 275 publications, 29 met the eligibility criteria: 3 systematic reviews, 6 case series, and 20 case reports. The study comprises 463 cases, mainly women (87%), with an average age of 39.94 years. The average time between infiltrations was 7.65 years. Infiltrated substances included silicone, oils, methyl methacrylate, guaiacol, sodium gadolinium, collagen, paraffin, and other unknown substances. The complications fell into three categories: local, systemic with inflammatory-immune response, and renal damage due to hypercalcemia induced by the granulomatosis caused by the substance. Treatment lacked uniformity, mainly focusing on the main effect. Surgical resection of affected tissue resulted in local and systemic improvement (renal, hypercalcemia, or inflammatory-immune) for most patients. Patients who received comprehensive treatment based on inflammatory-immune control, control of renal involvement, and resection of the tissue area that contained large amounts of the infiltrated substance had a better prognosis than those with diffuse infiltration and delayed treatment.
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Affiliation(s)
- Guillermo Ramos-Gallardo
- University of Guadalajara, Centro Universitario de la Costa; Asociación Mexicana de Cirugía Plástica, Estética y Reconstructiva.
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Fareen N, Ahmed Z, Ahmed Z, Hossain MA, Diraviam SP, Taj S, Masud A. Modifying Beauty Is Not Priceless: A Rare Case of Silicone-Induced Hypercalcemia With Renal Failure. Cureus 2022; 14:e25890. [PMID: 35720781 PMCID: PMC9203252 DOI: 10.7759/cureus.25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
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Kelly PJ, Frankel AS, D’Avanzo P, Suppes K, Shanker A, Sarwer DB. Psychosocial Differences Between Transgender Individuals With and Without History of Nonsurgical Facial Injectables. Aesthet Surg J Open Forum 2020; 3:ojaa050. [PMID: 33791671 PMCID: PMC7760569 DOI: 10.1093/asjof/ojaa050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Considerable research has explored psychosocial characteristics of individuals who seek aesthetic procedures as well as psychological changes experienced after successful treatment. Little research, however, has explored the experiences of transgender individuals who have undergone nonsurgical injectable procedures (NSIPs). OBJECTIVES This study examined theoretically relevant psychosocial characteristics of transgender individuals who have and have not undergone NSIPs. METHODS An online survey of demographic and psychosocial constructs was disseminated through transgender-specific support groups and Facebook groups from December 2019 to February 2020. Psychosocial measures included self-esteem (Rosenberg Self-Esteem Inventory), anticipated discrimination (Intersectional-Anticipated Discrimination), gender identity and physicality congruence (Transgender Congruence Scale), body image (Body Image Quality of Life Inventory), and overall satisfaction with facial appearance (FACE-Q Face Overall). The Mann-Whitney U test assessed differences by history of NSIPs, and the Kruskal-Wallis test assessed gender and racial differences. A P-value of <0.05 was considered significant. RESULTS Participants (N = 101) were transfeminine (n = 58), transmasculine (n = 31), gender-diverse (n = 12), and mostly (71%) white. Almost two-thirds of respondents (62%) reported using NSIPs; 6 participants reported undergoing NSIPs from non-licensed providers. History of NSIPs was associated with greater self-esteem (P < 0.01), less anticipated discrimination (P < 0.01), greater physicality and gender identity congruence(P < 0.001), greater body image quality of life (P < 0.001), and greater satisfaction with overall facial appearance (P < 0.01). CONCLUSIONS Use of NSIPs was associated with more positive psychosocial symptoms. Experiences with NSIPs may play an important role in psychosocial functioning for transgender individuals. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Patrick J Kelly
- Corresponding Author: Patrick J. Kelly, MPH, Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave, Room 947, Philadelphia, PA, USA. E-mail: ; Twitter: @PatrickJKelly7
| | - Anne S Frankel
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Paul D’Avanzo
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Katie Suppes
- Research and Evaluation, Bradbury-Sullivan LGBT Community Center, Allentown, PA, USA
| | - Adrian Shanker
- Bradbury-Sullivan LGBT Community Center, Allentown, PA, USA
| | - David B Sarwer
- Director of the Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
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Zouras S, Surya A, Abusahmin H, Hassan M, Humphreys E, Nagaraja P, Hurley J, Slowinska E, Das G. GRANULOMATOUS DISEASE OF UNUSUAL SITES CAUSING HYPERCALCEMIA: TWO CASE REPORTS. AACE Clin Case Rep 2020; 5:e44-e49. [PMID: 31966999 DOI: 10.4158/accr-2018-0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Hypercalcemia with suppressed parathyroid hormone (PTH) levels is mostly due to granulomatous disease (GD) or neoplastic disease. In GD, autonomous activity of extra-renal 1α-hydroxylase enzyme is usually the underlying cause. We describe a pair of cases where hypercalcemia resulted from GD of unusual sites posing significant diagnostic challenges. Methods We describe 2 cases of PTH-independent hypercalcemia due to GD of the prostate gland and the stomach. Results Both cases presented with marked hypercalcemia and suppressed PTH levels. Case 1 is an elderly male who presented with marked symptomatic hypercalcemia on multiple occasions. Investigations revealed elevated levels of 1,25-dihydroxyvitamin D3 and prostate-specific antigen but normal PTH-related protein. Transrectal biopsy of the prostate gland confirmed the presence of chronic granulomatous prostatitis. The patient responded very well to steroids which entirely normalized his calcium level. Case 2 is a male who presented similarly with significant hypercalcemia but had upper gastrointestinal symptoms and anemia at onset. Endoscopy and biopsy established the presence of granulomatous gastritis likely due to Crohn disease which responded to steroids resulting in normalization of calcium levels within a short span of time. Conclusion While the majority of PTH-independent hypercalcemia cases are due to GDs of lymph nodes or malignancy, our cases indicate that in uncertain cases, granulomatous processes involving unusual sites should be considered in the evaluation of hypercalcemia with suppressed PTH.
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Stowell JT, Grimstad FW, Kirkpatrick DL, Brown ER, Santucci RA, Crane C, Patel AK, Phillips J, Ferreira MA, Ferreira FR, Ban AH, Baroni RH, Wu CC, Swan KA, Scott SA, Andresen KJ. Imaging Findings in Transgender Patients after Gender-affirming Surgery. Radiographics 2019; 39:1368-1392. [DOI: 10.1148/rg.2019190010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.
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Abstract
BACKGROUND Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon. OBJECTIVE To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care. METHODS The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy. RESULTS In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections. CONCLUSION As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.
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Silicone-Induced Granulomatous Reaction Causing Severe Hypercalcemia: Case Report and Literature Review. Case Rep Nephrol 2019; 2019:9126172. [PMID: 30729052 PMCID: PMC6341244 DOI: 10.1155/2019/9126172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022] Open
Abstract
A 67-year-old woman presented to the hospital with complaints of abdominal pain. Physical exam was significant for signs of severe dehydration, mild epigastric tenderness and multiple non-tender hard nodules over her arms and thighs. Incidental finding of severe hypercalcemia led to negative workups for hyperparathyroidism, vitamin D intoxication, and malignancy. However, elevated levels of 1,25-hydroxy vitamin D raised the possibility of granulomatous diseases. Imaging and patient report revealed silicone-induced foreign body granulomatous reaction as the cause of hypercalcemia. Use of silicone for cosmetic enhancement of body contours can result in siliconomas, severe hypercalcemia, and complications. Treatment is unestablished for this condition. Increasing prevalence of cosmetic enhancement should prompt vigilance for this rare disease entity. Providers should counsel and educate individuals undergoing such procedures.
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Hamadeh M, Fares J. Diagnosis and management of hypercalcemia associated with silicone-induced granuloma. ACTA ACUST UNITED AC 2019; 64:575-576. [PMID: 30365655 DOI: 10.1590/1806-9282.64.07.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/25/2017] [Indexed: 11/21/2022]
Abstract
Hypercalcemia associated with silicone-induced granuloma is a rare disease. Diagnosis can be tricky as it is established after ruling out other hypercalcemia-causing entities. In addition, management is customized depending on the patient's wishes and possible solutions. We present a male bodybuilder, in his thirties, with multiple silicone injections in his upper extremities, who developed hypercalcemia and urinary symptoms. Advanced laboratory tests ruled out various causes of hypercalcemia and CT imaging revealed nephrocalcinosis. A biopsy of the upper arm showed granulomatous tissue and inflammation. The patient necessitated two sessions of dialysis and corticosteroids were given to relieve symptoms and reverse laboratory abnormalities. Silicone-induced hypercalcemia should be on high alert because of the increasing trend of body contour enhancements with injections, implants and fillers. Treatment should be optimized depending on the patient's needs and condition.
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Affiliation(s)
- Majdi Hamadeh
- Department of Nephrology and Hypertension, Al-Zahraa University Hospital, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Yedla N, Perez E, Lagari V, Ayala A. SILICONE GRANULOMATOUS INFLAMMATION RESULTING IN HYPERCALCEMIA: A REVIEW OF THE LITERATURE. AACE Clin Case Rep 2018; 5:e119-e123. [PMID: 31967015 DOI: 10.4158/accr-2018-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Silicone usage for cosmetic enhancement is common, although it is not approved by the U.S. Food and Drug Administration. Granulomatous inflammation leading to hypercalcemia is a rare complication. We present a case of non-parathyroid hormone (PTH), calcitriol-mediated hypercalcemia in a woman with a history of cosmetic injections. Methods Case report and review of the literature. Results A 48-year-old female with metabolic syndrome was evaluated for severe hypercalcemia (calcium >15 mg/dL). Laboratory tests revealed low-normal PTH, normal 25-hydroxyvitamin D, elevated 1,25-dihydroxyvitamin D, and hypercalciuria. Imaging studies, including a computed tomography (CT) scan of the lungs, was nonrevealing. Positron emission tomography/CT showed symmetric hypermetabolic subcutaneous stranding of bilateral gluteus and proximal thighs. She admitted to silicone injections in the buttocks 10 years prior. Her examination was unremarkable except for an intermittent pruritic rash over the right thigh. Labs revealed total serum calcium 11.3 mg/dL, PTH 18 pg/mL, 24-hour urinary calcium 509 mg, and PTH-related peptide 18 pg/mL. Serum and urine electrophoresis were normal, 25-hydroxyvitamin D was 47 pg/mL, and 1,25-dihydroxyvitamin D was 121 pg/mL. Angiotensin-converting enzyme level was 80 U/mL. A diagnosis of granulomatous inflammation resulting in calcitriol-mediated, PTH-independent hypercalcemia was entertained. Conclusion Silicone-induced hypercalcemia should be thought of in those with prior cosmetic injections. Tissue biopsy confirms the diagnosis, which is often delayed. We reviewed 19 cases with silicone usage and variable levels of hypercalcemia. Renal injury was common. One death was reported. Glucocorticoids, calcium restriction, and hydration have been used to treat calcitriol-mediated hypercalcemia but are not curative. Ketoconazole and bisphosphonates have been used with variable success. Surgical excision tends to be ineffective due to silicone migration. The treatment of this disorder is difficult and often ineffective.
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Mundluru SN, Larson AR. Medical dermatologic conditions in transgender women. Int J Womens Dermatol 2018; 4:212-215. [PMID: 30627619 PMCID: PMC6322154 DOI: 10.1016/j.ijwd.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Many previous reviews and studies on transgender dermatology have highlighted the expected dermatologic manifestations of hormone affirmation therapy in transgender patients. Others have highlighted attitudes and practices of both transgender patients and medical professionals taking care of these patients. This review compiles data from other, lesser known aspects of transgender dermatology, including neovaginal concerns, neoplastic concerns (both neovaginal and cutaneous), autoimmune conditions, and the sequelae of injectable substances that have not been approved by the U.S. Food and Drug Administration. This review, like others, will be a stepping-stone and serve as an impetus for future research in transgender dermatology.
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Affiliation(s)
- S N Mundluru
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - A R Larson
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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Fireman E, Rosengarten D, Zelinger E, Kramer MR. Interstitial lung diseases associated with metal content in silicone breast implants: a case series. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2018; 35:381-389. [PMID: 32476927 PMCID: PMC7170128 DOI: 10.36141/svdld.v35i4.7029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022]
Abstract
Background: Silicone gel-filled breast implants have been widely used for breast augmentation and reconstruction since the 1960's when the FDA approved them in women over 22 years of age. Concerns have been raised about the safety of those implants, with the focus upon whether silicone leak can spread to regional lymph nodes and remote organs and possibly cause inflammatory and immune responses. Objective: To present laboratory workup findings in 3 cases of interstitial lung diseases (ILD) linked with silicone implant leakage. Methods: ILD was diagnosed by tissue biopsy and Computerized Tomography (CT). We analyzed the metal content in both biological samples and raw material of the implants by means of scanning electron microscopy (SEM) and X-ray fluorescence (XRF). The metals lymphocyte proliferation analysis (MELISA®) was used to assess sensitization of the immune system to 19 metals. Results: The biological samples contained metals (silicon, nickel, zinc, tungsten, iron, aluminum, and zirconium) which are also present in the silicone implant. The MELISA test showed sensitization to nickel, zinc and tin. Limitations: Some of the immunogenic metals present in the implant were under the limits of detection of SEM and XRF and the sensitivity of MELISA test is unknown. Conclusions: The laboratory assessments of the 3 herein described women indicated that their interstitial lung disease was associated with the metal content of their silicone gel-filled breast implantations. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 381-389).
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Affiliation(s)
- Elizabeth Fireman
- Laboratory for Pulmonary and Allergic Diseases, Tel Aviv Medical Center, Tel Aviv, Israel, Environmental and Occupational Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Correspondence: Elizabeth Fireman, PhD, Laboratory for Pulmonary and Allergic Diseases, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel Tel. +972-3-6973988 Fax +972-3-6947264 E-mail:
| | - Dror Rosengarten
- Institute of Pulmonary Diseases, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Einat Zelinger
- The Interdepartmental Equipment Facility the HebrewUniversity Jerusalem, Israel
| | - Mordechai R. Kramer
- Institute of Pulmonary Diseases, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
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Noreña JA, Niño CD, Gallego S, Builes-Barrera CA, Castro DC, Román-González A, Jimenez C. Calcitriol-mediated hypercalcemia secondary to granulomatous disease caused by soft-tissue filler injection: a case report. ACTA ACUST UNITED AC 2017; 14:340-346. [PMID: 29354165 DOI: 10.11138/ccmbm/2017.14.3.340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Soft-tissue filler (STF) injections have been used worldwide for cosmetic reasons. In most cases, they are not approved by the United States Food and Drug Administration (FDA). Regulatory boards in Latin American countries do not allow the medical use of STF injections; however, these injections are still widely used. A case of calcitriol-mediated hypercalcemia with ectopic calcifications, chronic kidney disease, nephrolithiasis and calcinosis is presented. The reported case highlights the consequences of STF use, including calcitriol-mediated hypercalcemia secondary to granulomatous reactions years after an esthetic procedure.
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Affiliation(s)
| | - César Daniel Niño
- Department of Internal Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Sabrina Gallego
- Department of Plastic Surgery, Universidad de Antioquia and Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - Carlos Alfonso Builes-Barrera
- Section of Endocrinology and Diabetes, Department of Internal Medicine; Professor of Endocrinology Universidad de Antioquia, Medellin, Colombia.,Department of Endocrinology, Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - Diva Cristina Castro
- Department of Endocrinology, Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - Alejandro Román-González
- Section of Endocrinology and Diabetes, Department of Internal Medicine; Professor of Endocrinology Universidad de Antioquia, Medellin, Colombia.,Department of Endocrinology, Hospital Universitario San Vicente Fundacion, Medellin, Colombia
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Barilaro G, Spaziani Testa C, Cacciani A, Donato G, Dimko M, Mariotti A. ASIA syndrome, calcinosis cutis and chronic kidney disease following silicone injections. A case-based review. Immunol Res 2017; 64:1142-1149. [PMID: 27665458 DOI: 10.1007/s12026-016-8871-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An immunologic adjuvant is a substance that enhances the antigen-specific immune response preferably without triggering one on its own. Silicone, a synthetic polymer used for reconstructive and cosmetic purposes, can cause, once injected, local and/or systemic reactions and trigger manifestations of autoimmunity, occasionally leading to an overt autoimmune disease. Siliconosis, calcinosis cutis with hypercalcemia and chronic kidney disease have all been reported in association with silicone injection. Here, we describe a case of autoimmune/auto-inflammatory syndrome induced by adjuvants, calcinosis cutis and chronic kidney disease after liquid silicone multiple injections in a young man who underwent a sex reassignment surgery, followed by a review of the literature. To our knowledge, this is the first report describing the concomitance of the three clinical conditions in the same patients. The link between silicone and the immune system is not completely understood yet and requires further reports and investigations with long-term data, in order to identify the main individual and genetical risk factors predisposing to the wide spectrum of the adjuvant-induced responses.
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Affiliation(s)
- Giuseppe Barilaro
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy.
| | - Claudia Spaziani Testa
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Antonella Cacciani
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Giuseppe Donato
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Mira Dimko
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Amalia Mariotti
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
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Amiraian DE, Accurso JM, Jain MK. Severe Hypercalcemia Related to Silicone Granulomas, as Discovered by FDG-PET. Indian J Nucl Med 2017; 32:343-344. [PMID: 29142355 PMCID: PMC5672759 DOI: 10.4103/ijnm.ijnm_33_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Silicone injected for cosmetic purposes can provoke an inflammatory granulomatous response. In turn, silicone granulomas can lead to hypercalcemia, which is a rare, though potentially life-threatening condition. Hypercalcemia is a nonspecific laboratory finding with many potential etiologies. It may be difficult for clinicians to diagnose silicone-induced hypercalcemia, since the history of cosmetic silicone injections may not be elicited from the patient. Positron emission tomography using F-18-fluorodeoxyglucose (FDG-PET) can be used to evaluate patients with unexplained hypercalcemia as a means of searching for an occult malignancy or granulomatous process. FDG-PET findings may be the initial and perhaps only indication of silicone granulomas as the cause of hypercalcemia. Nuclear medicine physicians should have a low threshold for suggesting this diagnosis, particularly in the setting of unexplained hypercalcemia. This case report highlights the value of FDG-PET in diagnosing silicone granuloma-induced hypercalcemia.
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Affiliation(s)
- Dana E Amiraian
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Joseph M Accurso
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Manoj K Jain
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
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Hypercalcemia Secondary to Silicone Breast Implant Rupture: A Rare Entity to Keep in Mind. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1416. [PMID: 28831356 PMCID: PMC5548579 DOI: 10.1097/gox.0000000000001416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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The Changing Profile of Hypercalcemia in Hospital Populations. Clin Rev Bone Miner Metab 2017. [DOI: 10.1007/s12018-017-9231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Granda ML, Huang LE. Silicone Injection–Related Granulomatous Hypercalcemia. Am J Med Sci 2017; 353:492-494. [DOI: 10.1016/j.amjms.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Melnick S, Abaroa-Salvatierra A, Deshmukh M, Patel A. Calcitriol mediated hypercalcaemia with silicone granulomas due to cosmetic injection. BMJ Case Rep 2016; 2016:bcr-2016-217269. [PMID: 27993822 DOI: 10.1136/bcr-2016-217269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 41-year-old woman with medical history significant for urolithiasis presenting to our hospital for psychiatric evaluation due to worsening depression and suicidal ideations for the past 2 weeks. Initial laboratory results show hypercalcaemia of 13.5 mg/mL that led to consulting internal medicine. On further questioning, the patient admitted to cosmetic silicone injections in her buttocks which were causing calcium deposition under her skin, leading to disfigurement of the sacrum and lumbar regions. She underwent further evaluation with CT and laboratory testing, which effectively ruled out malignancy and primary hyperparathyroidism. The hypercalcaemia was diagnosed as non-PTH-dependent with high levels of 1,25-dihydroxyvitamin D and low PTH. She eventually underwent tissue biopsy confirming the presence of silicone granulomas responsible for the calcitriol-mediated hypercalcaemia. This case reminds one to keep a broad differential especially in patients with hypercalcaemia in which malignancy and primary hyperparathyroidism have been ruled out.
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Affiliation(s)
- Stephen Melnick
- Department of Internal Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania, USA.,Lebanon, Pennsylvania, USA
| | | | - Mrunalini Deshmukh
- Department of Internal Medicine, Reading Health System, Reading, Pennsylvania, USA
| | - Arti Patel
- Reading Health System, Reading, Pennsylvania, USA
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Lungu E, Thibault-Lemyre A, Dominguez JM, Trudel D, Bureau NJ. A case of recurrent leg necrotic ulcers secondary to silicone migration in a transgender patient: radiographic, ultrasound and MRI findings. BJR Case Rep 2016; 2:20150309. [PMID: 30364371 PMCID: PMC6195932 DOI: 10.1259/bjrcr.20150309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/10/2015] [Indexed: 11/06/2022] Open
Abstract
Injection of massive quantities of liquid silicone into body parts for cosmetic purposes is a popular practice among the transgender population. Although a myriad of short-term complications associated with this procedure have been described, few reports of chronic and persistent ailments exist. We present the case of a male-to-female transgender with recurrent necrotic leg ulcers associated with migration of the silicone material injected in the buttocks 25 years ago. We review the imaging findings as well as the clinical and pathological aspects of this presentation, with an emphasis on the necessity of a high degree of suspicion for silicone-associated complications in a transgender patient presenting with leg wounds. We highlight the importance of the characteristic sonographic snowstorm artefact generated by free silicone material in soft tissues in the diagnosis of this entity.
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Affiliation(s)
- Eugen Lungu
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | | | | | - Dominique Trudel
- Department of Pathology, Centre Hospitalier de l´Université de Montréal, Montréal, Canada
| | - Nathalie J Bureau
- Radiology Department, Centre Hospitalier de l´Université de Montréal, Montréal, Canada
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21
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Abstract
Hypercalcemia occurs in up to 4% of the population in association with malignancy, primary hyperparathyroidism, ingestion of excessive calcium and/or vitamin D, ectopic production of 1,25-dihydroxyvitamin D [1,25(OH)2D], and impaired degradation of 1,25(OH)2D. The ingestion of excessive amounts of vitamin D3 (or vitamin D2) results in hypercalcemia and hypercalciuria due to the formation of supraphysiological amounts of 25-hydroxyvitamin D [25(OH)D] that bind to the vitamin D receptor, albeit with lower affinity than the active form of the vitamin, 1,25(OH)2D, and the formation of 5,6-trans 25(OH)D, which binds to the vitamin D receptor more tightly than 25(OH)D. In patients with granulomatous disease such as sarcoidosis or tuberculosis and tumors such as lymphomas, hypercalcemia occurs as a result of the activity of ectopic 25(OH)D-1-hydroxylase (CYP27B1) expressed in macrophages or tumor cells and the formation of excessive amounts of 1,25(OH)2D. Recent work has identified a novel cause of non-PTH-mediated hypercalcemia that occurs when the degradation of 1,25(OH)2D is impaired as a result of mutations of the 1,25(OH)2D-24-hydroxylase cytochrome P450 (CYP24A1). Patients with biallelic and, in some instances, monoallelic mutations of the CYP24A1 gene have elevated serum calcium concentrations associated with elevated serum 1,25(OH)2D, suppressed PTH concentrations, hypercalciuria, nephrocalcinosis, nephrolithiasis, and on occasion, reduced bone density. Of interest, first-time calcium renal stone formers have elevated 1,25(OH)2D and evidence of impaired 24-hydroxylase-mediated 1,25(OH)2D degradation. We will describe the biochemical processes associated with the synthesis and degradation of various vitamin D metabolites, the clinical features of the vitamin D-mediated hypercalcemia, their biochemical diagnosis, and treatment.
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Affiliation(s)
- Peter J Tebben
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Ravinder J Singh
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Rajiv Kumar
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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Abstract
The metabolic pathways that contribute to maintain serum calcium concentration in narrow physiological range include the bone remodeling process, intestinal absorption and renal tubule resorption. Dysbalance in these regulations may lead to hyper- or hypocalcemia. Hypercalcemia is a potentionally life-threatening and relatively common clinical problem, which is mostly associated with hyperparathyroidism and/or malignant diseases (90 %). Scarce causes of hypercalcemia involve renal failure, kidney transplantation, endocrinopathies, granulomatous diseases, and the long-term treatment with some pharmaceuticals (vitamin D, retinoic acid, lithium). Genetic causes of hypercalcemia involve familial hypocalciuric hypercalcemia associated with an inactivation mutation in the calcium sensing receptor gene and/or a mutation in the CYP24A1 gene. Furthermore, hypercalcemia accompanying primary hyperparathyroidism, which develops as part of multiple endocrine neoplasia (MEN1 and MEN2), is also genetically determined. In this review mechanisms of hypercalcemia are discussed. The objective of this article is a review of hypercalcemia obtained from a Medline bibliographic search.
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Affiliation(s)
- I. ŽOFKOVÁ
- Institute of Endocrinology, Prague, Czech Republic
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23
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Resection of granulomatous tissue resolves silicone induced hypercalcemia. Bone Rep 2015; 5:163-167. [PMID: 28580383 PMCID: PMC5440967 DOI: 10.1016/j.bonr.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Because of the increasing trend of body contour enhancements with injections, implants, and fillers, clinicians should be on high alert for the possibility of silicone-induced hypercalcemia as one of the differential diagnoses in a patient with history of silicone use. Hypercalcemia as a result of silicone injections has been reported, and there is concern that there will be more cases given the popularity of cosmetic silicone. Cases involved a mother and daughter (70 & 55 years) who presented in 2013 with hypercalcemia after cosmetic silicone injections in 2007. Evaluation showed 1, 25-dihydroxyvitamin D-mediated hypercalcemia and progressive renal dysfunction; lymph node biopsy showed granulomatous silicone lymphadenitis. MRI of the pelvis revealed abnormal signal enhancement within the subcutaneous gluteal adipose tissue and enlarged inguinal lymph nodes. For persistent hypercalcemia and hypercalciuria, surgical resection of silicone material and granulomas is a successful approach to normalize the serum calcium level. One of the first reports of resolution of hypercalcemia by surgical intervention High possibility of silicone-induced hypercalcemia Surgical resection silicone material and granulomas is a successful approach. We aim to encourage the awareness of this condition among clinicians.
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