![]() Our patient demonstrated persistent elevation in ionized calcium despite achieving a normal serum calcium. 1 Ionized calcium is considered a more sensitive marker of PHPT severity. 7 However, a small number of PHPT patients present with ionized calcium elevation without an elevated total calcium. Guidelines for the management of PHPT are based on total serum calcium levels. Due to patient variability, long-term clinical follow-up and longer duration of treatment are necessary. 6 Other cases have reported on a small proportion of patients who experience slightly elevated calcium levels after vitamin D treatment. 3 However, studies suggest that vitamin D supplementation reduces PTH without adversely affecting serum calcium. Many physicians restrict vitamin D supplements for fear of aggravating hypercalcemia in PHPT. The urinary calcium, which is generally elevated in PHPT, is low in vitamin D deficiency and may have accounted for her relatively low urine calcium excretion. ![]() 5 The decline in this patient’s PTH level after treatment suggests that part of the PTH elevation was related to vitamin D deficiency ( Figure 1). Traditionally, parathyroidectomy procedures have been the definitive treatment for PHPT. We believe this to be the first reported case of normalization of total calcium following vitamin D replacement. A dual energy x-ray absorptiometry bone density scan indicated a T score of –1.5 in the left femoral neck. Magnesium and phosphorus measurements were normal. PHPT appeared likely given the history of kidney stones, positive parathyroid scan, elevated PTH values, and total calcium levels at the upper limit of normal. Single photon emission computed tomography/computed tomography imaging revealed a right lower pole parathyroid adenoma. She did admit to intermittent compliance with her vitamin D. Her vitamin D levels had improved ( Figure 1). The urine calcium was 108 mg/24 h (normal value 100–300). Her total calcium and ionized calcium now were 11.3 mg/dL and 6.0 mg/dL (normal value 4.8–5.6), respectively. The vitamin D regimen was switched to vitamin D3 5000 IU/day, and the patient was instructed to cease multivitamin intake.Īt 8 months, her fatigue had lessened. PTH levels were on the upper end of normal, measuring 62 pg/mL. Subsequent laboratory results revealed a 25-OH vitamin D of 17 ng/mL, an ionized calcium of 5.6 mg/dL (normal value 4.8–5.6), and a total calcium of 10.3 mg/dL (normal value 8.6–10.3) with an albumin of 3.8 g/dL. She was started on vitamin D2 50,000 IU/week and a daily multivitamin. Her PTH was 86.8 pg/mL (normal value 14–72) and her 25-OH vitamin D level was 8.2 ng/mL (normal value 30–100). She complained of fatigue and denied a family history of calcium issues. A 51-year-old Asian woman with known hypertension and a remote history of renal stones presented with hyperparathyroidism and vitamin D deficiency.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |