RESUMO
SUMMARY Hypercalcemia is a frequent condition in clinical practice and when the most frequent causes are excluded, etiological diagnosis can be challenging. A rare cause of PTH-independent hypercalcemia is described in the present case report. A male adult with a history of androgenic-anabolic steroids abuse, and injection of mineral oil and oily veterinary compound containing vitamins A, D and E into muscles for local hypertrophy presented with hypercalcemia, nephrocalcinosis, and end-stage renal disease. On physical examination, the presence of calcified subcutaneous nodules and calcification of musculature previously infused with oily substances drew attention. Laboratory tests confirmed hypercalcemia of 12.62 mg/L, low levels of PTH (10 pg/mL), hyperphosphatemia (6.0 mg/dL), 25(OH)D of 23.3 ng/mL, and elevated 1,25(OH)2D (138 pg/mL). Imaging exams showed diffuse calcification of muscle tissue, subcutaneous tissue, and organs such as the heart, lung, and kidneys. The patient was diagnosed with PTH-independent hypercalcemia secondary to foreign body reaction in areas of oil injection. The patient underwent treatment with hydrocortisone for 10 days, single dose zoledronic acid and hemodialysis. He evolved with serum calcium levels of 10.4 mg/dL and phosphorus of 7.1 mg/dL. In addition, sertraline and quetiapine were prescribed to control body dysmorphic disorder. The medical community should become aware of new causes of hypercalcemia as secondary to oil injection since this should become increasingly frequent due to the regularity with which such procedures have been performed.
RESUMO
Este estudo consiste em um relato de experiência derivada do PET-Saúde, implantado na UnB e inserido na realidade da comunidade do Paranoá-DF, durante o período 2009-2010. Entre as atividades desenvolvidas, estão: a elaboração de instrumento de dados estruturado em moldes da Medicina da Família; a criação de um portfólio eletrônico; a realização de oficinas de capacitação; entre outras. Dos resultados obtidos, foi possível verificar uma mudança na postura acadêmica, formando futuros profissionais mais críticos, reflexivos, empáticos e preocupados efetivamente com a Atenção Primária à Saúde.
This study is composed of a report of experience derived from PET-Health, established in UNB and inserted into the reality of community Paranoá-DF, during the period 2009-2010. Among the activities are: development of an instrument of data structured in a manner of Family Medicine; the creation of an electronic portfolio, the holding of training workshops, among others. From the acquired results, it was observed a change in academic attitude, making future professionals more critical, thoughtful, empathetic and really concerned with the Primary Health Care.