<prompt> Answer this question truthfullyWhat does Hypervitaminosis D mean?  <response>: <reason> Deaths by vitamin poisoning appear to be quite rare in the US, typically none in a given year. However before 1998, several deaths per year were typically associated with pharmaceutical iron-containing supplements, especially brightly-colored, sugar-coated, high-potency iron supplements, and most deaths were children . Unit packaging restrictions on supplements with more than 30 mg iron have since reduced deaths to 0 or 1 per year . These statistics compare with 59 deaths due to aspirin poisoning in , 147 deaths associated with acetaminophen-containing products in , and an average of 54 deaths per year due to lightning for .Hypervitaminosis Dmust be differentiated from other causes of hypercalcaemiaDifferential diagnosis of hyperparathyroidism on the basis of hypercalcemia Disorder Mechanism of hypercalcemia Clinical features Laboratory findings Imaging diagnostic modalities PTH Calcium Phosphate Other findings Hyperparathyroidism Primary hyperparathyroidism Increase in secretion of parathyroid hormone PTH from a primary process in parathyroid gland. Parathyroid hormone causes increase in serum calcium. Usually asymptomatic Hypercalcemia detected on routine biochemical panel Normal Normal calcitriol Findings of bone resorption: X-ray Dual energy X-ray absorptiometry DXA Preoperative localization of hyperfunctioning parathyroid gland: Non-Invasive Tc-99m sestamibi scintigraphy Neck ultrasound 4D-CT SPECT P-SPECT PET MRI Invasive: Super sensitive venous sampling Selective arteriography Angiography Predicting post-operative success: Intraoperative parathyroid hormone monitoring Secondary hyperparathyroidism Increase in secretion of parathyroid hormone PTH from a secondary process. Parathyroid hormone causes increase in serum calcium after long periods. May present with history of: Chronic renal failure Vitamin D deficiency Normal -- Tertiary hyperparathyroidism Continuous elevation of parathyroid hormone PTH even after successful treatment of the secondary cause of elevated parathyroid hormone. Parathyroid hormone causes increase in serum calcium. Usually present with history of kidney transplant Usually hyperplasia of all four parathyroid glands -- Familial hypocalciuric hypercalcemia This is a genetic disorder caused my mutation in calcium-sensing receptor gene. A benign condition Does not require treatment Normal Normal -- -- Urinary calciumcreatinine clearance ratio Malignancy Humoral hypercalcemia of malignancy Tumor cells secretes parathyroid hormone-related protein PTHrP which has similar action as parathyroid hormone. Most common cause of malignancy related hypercalcemia Usually present with solid tumors -- Normal PTHrP Normal calcitriol Chest X-ray CT scan MRI Osteolytic tumors Multiple myeloma produces osteolysis of bones causing hypercalcemia. Osteolytic metasteses can cause bone resorption causing hypercalcemia. Commonly present in multiple myeloma and breast cancer -- -- DXA X-ray Mammography Ultrasound ESR Serum protein electrophoresis Production of calcitirol Some tumors has ectopic activity of 1-alpha-hydroxylase leading to increased production of calcitriol. Calcitriol is active form of vitamin D and causes hypercalcemia. Commonly present in lymphomas and in some ovarian germ cell tumors -- -- Calcitriol CT scan MRI Ectopic parathyroid hormone Some tumors leads to ectopic production of parathyroid hormone. In rare instances, small cell carcinoma of lung may produce hypercalcemia by this process Normal Normal calcitriol Chest X-ray CT scan MRI Medication induced Lithium Lithium lowers urinary calcium and causes hypercalcemia. Lithium has been reported to cause an increase in parathyroid hormone and enlargement if parathyroid gland after weeks to months of therapy. History of mood disorder -- -- Lithium levels Thiazide diuretics Thiazide diuretics lowers urinary calcium excretion and causes hypercalcemia. History of cardiac disorder Rarely causes hypercalcemia -- -- -- -- Nutritional Milk-alkali syndrome Hypercalcemia is be caused by high intake of calcium carbonate. History of High milk intake Excess calcium intake for treating: Osteoporosis Dyspepsia May lead to metabolic alkalosis and renal insufficiency. -- -- -- Renal function tests Vitamin D toxicity Excess vitamin D causes increased absorption of calcium from intestine causing hypercalcemia. History of: Excess intake vitamin D Excess milk fortified with vitamin D Topical application of vitamin D analogue calcipotriol -- -- Vitamin D calcidiol andor calcitriol -- Granulomatous disease Sarcoidosis Hypercalcemia is causes by endogeous production of calcitriol by disease-activated macrophages. History of: Cough Dyspnea Chest pain Tiredness or weakness Fever Weight loss -- -- Calcitriol ACE levels Chest X-ray Biopsy 