HYPERVITAMINEMIA B12 IN THE ELDERLY - A FORGOTTEN MARKER OF SERIOUS UNDERLYING DISEASES

Sep 23, 2026

Uploaded by Adam

Hypervitaminemia B12, long neglected in clinical practice, is a biological anomaly whose pathological significance remains largely underestimated, particularly in the elderly. Elevated B12 levels may signal serious underlying conditions, including solid neoplasia, haematological malignancies, chronic liver disease, or renal failure. A 91-year-old man with asthenia and anorexia showed major hypervitaminemia (1318 pg/ml), later linked to alcoholic cirrhosis complicated by metastatic hepatocellular carcinoma. The article highlights prognostic value of B12 dosage with the BCI index and supports reassessing routine B12 testing in geriatric oncology settings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Learning points

Introduction/Background

Case description

Summary of biological data

HYPERVITAMINEMIA B12 IN THE ELDERLY: A FORGOTTEN MARKER OF SERIOUS UNDERLYING DISEASES Abrar-Ahmad Zulfiqar Department of Internal Medicine, University Hospital of Strasbourg, Strasbourg, France Corresponding author’[s e-mail:](s e-mail: abzulfiqar@gmail.com)[ abzulfiqar@gmail.com](s e-mail: abzulfiqar@gmail.com) Received: 17/06/2025 Accepted: 24/06/2025 Published: 03/07/2025 Conflicts of Interests: The Authors declare that there are no competing interests. Patient Consent: Written informed consent was obtained from the patient to secure permission for publishing their clinical history. This article is licensed under a Commons Attribution Non-Commercial 4.0 License How to cite this article: Zulfiqar AA. Hypervitaminemia B12 in the elderly: a forgotten marker of serious underlying diseases. EJCRIM 2025;12:doi:10. 12890/2 025_005553 ABSTRACT Hypervitaminemia B12, long neglected in clinical practice, is a biological anomaly whose pathological significance remains largely underestimated, particularly in the elderly. While medical attention has historically focused on vitamin B12 deficiency, several recent studies suggest that elevated levels of this vitamin may reveal serious underlying pathologies, such as solid neoplasia, haematological malignancies, chronic liver disease or renal failure. We report the case of a 91-yearold man hospitalized for asthenia, anorexia and altered general condition, in whom vitamin B12 assay revealed major hypervitaminemia (1318 pg/ml). The work-up revealed hepatic cirrhosis of alcoholic origin, complicated by hepatocellular carcinoma which was metastatic from the outset. This case illustrates the potential prognostic value of vitamin B12 dosage, particularly when coupled with C-reactive protein (BCI index), a high value (> 40,000) of which is associated with shortterm mortality in patients with advanced cancer. Beyond hepatopathy, hypervitaminemia B12 is associated in the literature with increased haptocorrin release in myeloproliferative syndromes, excess transcobalamins in renal failure, or paradoxical elevation in certain inflammatory diseases. This biological marker, which is easy to obtain, could therefore become part of standardized geriatric assessment, particularly in oncogeriatrics, in order to guide diagnostic and prognostic strategy. The systematic inclusion of vitamin B12 assays in the general assessment of elderly patients, particularly in oncology settings, deserves to be reassessed. KEYWORDS Hypervitaminemia B12, elderly, B12 × CRP index (BCI), prognostic marker, neoplasia LEARNING POINTS • Hypervitaminemia B12 is an often overlooked but potentially significant marker of serious underlying pathologies—including solid neoplasms, liver disease, renal failure, and hematologic malignancies—especially in elderly patients. • The B12 × C-reactive protein (CRP) index, easily obtainable from routine labs, may serve as a prognostic tool in oncology, with values over 40,000 being strongly associated with short-term mortality in advanced cancers. • Routine screening for vitamin B12 levels in geriatric assessments should consider both deficiency and excess, with hypervitaminemia prompting systematic diagnostic evaluation to uncover latent or advanced disease. © EFIM 2025-European Journal of Case Reports in Internal Medicine-Doi: 10. 12890/2025_005553 INTRODUCTION/BACKGROUND High serum cobalamin (vitamin B12) has long been amisunderstood and underestimated anomaly, being considered as irrelevant from a diagnostic and clinical standpoint. Both fundamental and clinical research efforts were indeed concentrated, for a long time, on cobalamin deficiency[1]. Hypervitaminemia B12 is a biological anomaly that is largely underestimated because it is poorly understood. To date, there is no consensus as to what should be done in the event of an elevated vitamin B12 level. Research efforts have focused mainly on vitamin B12 deficiency, linked either to the syndrome of

FAQs

Why is hypervitaminemia B12 often underestimated in elderly patients?

It is poorly understood and has historically received less clinical attention than vitamin B12 deficiency, leading to an underestimation of its pathological significance in older adults.

What serious conditions can elevated vitamin B12 levels suggest?

Recent studies cited in the text associate high B12 levels with solid neoplasia, haematological malignancies, chronic liver disease, and renal failure.

How is the B12 × CRP index (BCI) related to prognosis?

The article reports that a high BCI value (> 40,000) is associated with short-term mortality in patients with advanced cancer.

Sep 23, 2026

Uploaded by Adam