Decreased Parathyroid Hormone Levels Despite Persistent Hypocalcemia in Patients with Kidney Failure Recovering from Septic Shock

Abstract

The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.

25-hydroxyvitamin D and parathyroid hormone in new onset sepsis: A prospective study in critically ill patients

“…We also showed that 84 % of our patients presented a blunted parathyroid response to decreased circulating vitamin D. This result is in agreement with a recent study in critically ill children with sepsis [ 39 ]. However, studies in critically ill adults with or without sepsis have supported an elevated PTH, contrary to our findings [ [40] , [41] , [42] ]. In a pilot study of 37 critically ill patients, Carlstedt et al found increased PTH that was associated with the severity and a poor outcome [ 41 ].…”

Evolutionary medicine and bone loss in chronic inflammatory diseases—A theory of inflammation-related osteopenia

“…Importantly, parathyroid hormone (PTH) is often elevated in acute inflammation such as septic shock (55), sepsis (56), or after endotoxin injection (57), but levels are normal, high, or low in chronic inflammation (58–62). Catabolic effects of PTH on bone might be largely determined by parallel inflammation (6) or by an increase in parallel glucocorticoids (63).…”