Macrophages within PMMA-induced granulomas may produce extra-renal CYP27B1 (alpha 1 hydroxylase), leading to increased calcitriol production and subsequent hypercalcemia.(4) Subsequent case reports have also highlighted the severity and often irreversible kidney damage associated with PMMA-induced hypercalcemia; however, a definitive and effective treatment remains elusive. Here, CYP27B1 is linked to hypercalcemia disease.