Category: Calcium/Bone Disorders

Monitor: 8

8 - A MISSING KEY IN A CHRONIC SYMPTOMATIC HYPOPARATHYROID PATIENT

Saturday, Apr 27
11:30 AM – 12:00 PM

Objective :

Hypoparathyroidism refers to parathyroid deficiency leading to hypocalcemia, hyperphosphatemia, and hypercalciuria with no one treatment suitable to every patient.


Methods :

We report a case of a 40 year old woman who presented with chronic debilitating symptoms of hypoparathyroidism and resistance to standard hypoparathyroid treatment.


Results : N/A


Discussion :

A 40 year old female presented with chronic debilitating symptoms of Hypoparathyroidism secondary to total thyroidectomy for a large multinodular goiter fifteen years ago. Despite compliance to treatment which included high doses of calcitriol, calcium supplements, hydrochlorothiazide along with frequent use of IV calcium gluconate her symptoms persisted which varied from seizures to painful carpopedal spasms. Malabsorption was ruled out through extensive tests and a trial of teretarapide failed to improve her calcium level. PTH 1-84 (Natpara) could not be arranged. As a last trial to her already maximized medical treatment she was started on high doses of cholecalciferol (Vitamin D3) with new data favoring the efficacy of high dose inactivated Vitamin D  in chronic hypoparathyroid patients, Vitamin D2 being the favored option and eliminating the prior misapprehensions regarding hypercalcemia and renal toxicity due  the  half-life of inactivated Vitamin D2.This small addition to her treatment improved  her chronic symptoms with remarkable improvement both clinically and biochemically leading to her first ever normalized calcium values in last 15 years of her illness along with subsequent reduction in the doses of calcitriol and calcium carbonate.


Conclusion :

Treatment with high doses of Vitamin D3 (cholecalciferol) in chronic hypoparathyroid patients seems to be  the missing key in resistant hypoparathyroidism cases.

SHORT URL FUNCTION-->

Sumerah Jabeen

fellow
Aga khan university hospital, karachi, Pakistan, Sindh, Pakistan

Dr. Sumerah Jabeen is an endocrine fellow at Aga Khan University Hospital. Being raised in a developing country like Pakistan with limited resources it is important to have an institutional support that dusts off your raw skills and helps you become more productive and for that I am lucky to be in one of the best fellowship programmes of my country.
Good research work takes a lot of effort and submitting this abstract at an international forum is a step closer to becoming more experienced at it. Recently I had a case report published in AACE journals and a letter to the editor in a local medical journal. My only original research article includes a manuscript on NIFTP which is currently under the process of submission.
Besides research, learning the core endocrine basics is a target for a budding endocrine fellow like me at present because endocrine due to its diversity requires a lot of skill for making a clinical diagnosis before ordering a battery of relevant tests.

Aisha Sheikh

Lecturer
The Aga Khan University
Karachi, Pakistan

Dr. Aisha Sheikh is FCPS (Medicine), she did her Fellowship training in Diabetes, Endocrinology and Metabolism from The Aga Khan University Hospital, Karachi, Pakistan and later did her Post-graduate diplomas in Diabetes and Endocrinology from UK. She is Consultant Endocrinologist and is affiliated as faculty member with The Aga Khan University, Medicell Institute of Diabetes, Endocrinology & Metabolism and University of South Wales, UK. She is actively involved in medical education and research and has published several research papers and a book chapter on "Hyperthyroidism and pregnancy" and "Diabetes and Ramadan" . She holds the position of Vice President Sindh of Pakistan Endocrine Society. She has keen interest in antenatal Diabetes & Endocrinology and has played a key role in development of Gestational Diabetes Mellitus recommendations and action plan from the platform of South Asian Federation of Endocrine Societies (SAEFS).