Discordant Calcium and Parathyroid Hormone with Presumed Epileptic Seizures
| Autor: | Chantal van Niekerk, Tanja Kemp, Bettina Chale-Matsau, Tahir S Pillay |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Vitamin Adult medicine.medical_specialty medicine.drug_class Clinical Biochemistry Parathyroid hormone chemistry.chemical_element 030209 endocrinology & metabolism Calcium Calcium Carbonate 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Seizures Internal medicine Vitamin D and neurology Chromogranins GTP-Binding Protein alpha Subunits Gs Medicine Humans Pseudohypoparathyroidism Chvostek sign Hypocalcemia business.industry Hydroxycholecalciferols Biochemistry (medical) Alfacalcidol DNA Methylation medicine.disease Vitamin D Deficiency Phosphate binder 030104 developmental biology Endocrinology chemistry Parathyroid Hormone Female medicine.symptom business |
| Zdroj: | Clinical chemistry. 64(3) |
| ISSN: | 1530-8561 |
| Popis: | A 33-year-old woman presented for the first time at the age of 9 years with recurrent seizures and was subsequently treated for epilepsy for 2 years. At 11 years of age, it was noted that the patient had hypocalcemia with an increased parathyroid hormone (PTH)4 measured with use of an intact PTH assay. Serum calcium was 5.73 mg/dL [1.43 mmol/L; reference interval (RI) 8.82–10.42 mg/dL (2.2–2.6 mmol/L)]; serum phosphate was 10.42 mg/dL [3.36 mmol/L; RI 1.86–4.34 mg/dL (0.6–1.4 mmol/L)]; and PTH was 319.68 pg/mL [33.9 pmol/L; RI 8.49–68.84 pg/mL (0.9–7.3 mmol/L)]. Vitamin D (Total 25-OH; 25-OH D2 and D3) concentrations, magnesium concentrations, liver and renal function tests were all normal. No other endocrine abnormalities such as thyroid or gonadotropin resistance were detected. The patient also was of short stature and was overweight. However, she became overweight after the age of 13 years (body mass index at 13 years was 22.8 kg/m2), and the short stature was not significant, as she was at the lower end of the RI for height at 1.55 m. There was no cognitive impairment. Positive Chvostek sign was observed but not Trousseau sign. The patient was placed on active vitamin D (alfacalcidol) and calcium supplements. The patient was followed up for 13 years; selected laboratory results are presented in Table 1. Although the patient was managed on calcium supplements and active vitamin D and followed up at a tertiary endocrine clinic, serum phosphate concentrations remained persistently high (Table 1). This was attributed to intermittent noncompliance and unavailability of active vitamin D. The patient had also been prescribed calcium carbonate as a phosphate binder. View this table: Table 1. Trends of calcium, phosphate, and parathyroid hormone concentrations over 13 years of follow-up.a ### QUESTIONS TO CONSIDER 1. What are the causes of hypocalcemia with an increased PTH concentration? 2. What is the explanation for … |
| Databáze: | OpenAIRE |
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