Glucocorticoid-Induced Hypocalcemia in a Patient with Established Hypoparathyroidism

Onyema, Michael C.; Kearney, Jessica; Dimitriadis, Georgios K.

doi:10.1016/j.amjmed.2020.10.040

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…Perioperative glucocorticoid (GC) treatment may also exacerbate underlying hypocalcemia and hypoparathyroidism in the postoperative period for patients with 22q11DS. Previous research has suggested that in patients with parathyroid dysfunction, GC treatment may induce clinically significant hypocalcemia [ 9 , 10 ]. GC administration may reduce dietary calcium absorption and may also increase renal calcium excretion.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Hypocalcemia following Non-Cardiac Surgical Procedures in Children with 22q11.2 Deletion Syndrome

Arganbright

Tracy

Feldt

et al. 2022

Genes

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The guidelines for management of children with 22q11.2 deletion syndrome (22q11DS) highlight the risk for developing hypocalcemia after surgery and recommend monitoring calcium perioperatively. Despite this guidance, little has been published on postoperative hypocalcemia and 22q11DS. Our goals were to evaluate the frequency of perioperative calcium monitoring and examine how often postoperative hypocalcemia was identified. This is a retrospective chart review of patients in our 22q Center’s repository. Inclusion criteria were a diagnosis of 22q11DS and a history of a non-cardiac surgical procedure. Data collected included all non-cardiac surgeries and perioperative calcium labs. In total, 68 patients were included and underwent 305 on-cardiac surgeries. Patients in only 17% of these surgeries had postoperative calcium testing, but of those tested, 58% showed hypocalcemia. Patients with history of hypocalcemia at the time of chart review undergoing non-cardiac surgeries were tested postoperatively 40% of the time; however, 67% of these had hypocalcemia. Similarly, for patients without history of hypocalcemia, postoperative testing occurred 60% of the time, with 52% of these having hypocalcemia. This study demonstrates that postoperative hypocalcemia in children with 22q11DS following non-cardiac surgeries is common and affects patients both with and without prior history of hypocalcemia. These data support establishing a protocol for perioperative testing/management of hypocalcemia for patients with 22q11DS.

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Section: Discussionmentioning

confidence: 99%

Postoperative Hypocalcemia following Non-Cardiac Surgical Procedures in Children with 22q11.2 Deletion Syndrome

Arganbright

Tracy

Feldt

et al. 2022

Genes

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Prednisolone

2021

Reactions Weekly

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COVID‐19‐Induced Refractory Symptomatic Hypocalcemia in a Patient With Parathyroid Gland Reimplantation

Tse,

Yeung

2024

Case Reports in Endocrinology

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Background: Several cases of severe hypocalcemia in the setting of COVID‐19 have been reported. The proposed mechanisms include direct viral interaction with ACE2 receptors in the parathyroid gland, viral chelation of calcium, worsening hypovitaminosis D, critical illness leading to unbound fatty acids binding calcium, and inflammatory cytokines leading to PTH resistance. Given the life‐threatening nature of hypocalcemia, this underrecognized phenomenon should be on the forefront of the clinician’s attention. This case highlights a rare manifestation of COVID‐19 and further complicated by the patient’s reimplanted parathyroid gland.Presentation: A 73‐year‐old female with primary hyperparathyroidism status post parathyroidectomy with reimplantation in the left forearm presented with 4 days of viral syndrome, found to have tetany and Chvostek’s sign on physical exam. Pertinent laboratory abnormalities included calcium 5.3 mg/dL, ionized calcium 0.44 mmol/L, magnesium 1.4 mg/dL, phosphorous 5.5 mg/dL, PTH 242 pg/mL, and 25‐OH vitamin D 56 ng/mL. Chest CT revealed multifocal pneumonia consistent with positive COVID‐19 testing. She was subsequently admitted to the ICU for severe, symptomatic hypocalcemia and was initiated on a continuous calcium infusion, remdesivir, baricitinib, and steroids. Tetany resolved after 9 g calcium repletion, and she was transferred to the medical floor with an ionized calcium of 0.83 mmol/L. On hospital day 3, repeat ionized calcium was 0.78 mmol/L despite ongoing repletion. Given the persistence of hypocalcemia, a repeat PTH level was obtained which remained high at 487 pg/mL, suggesting ongoing PTH interference in the setting of COVID‐19. PTH was obtained from the right (nonimplanted) arm which was normal at 74 pg/mL. This indicated an appropriate PTH response from the reimplanted gland, and that ongoing hypocalcemia may be due to insufficient PTH function to maintain systemic calcium levels or a peripheral interference with PTH level. With continued calcium supplementation and treatment of COVID‐19, the patient’s calcium stabilized at 8.6 mg/dL. She was discharged on oral calcium supplementation with endocrinology follow‐up.Conclusion: Acute hypocalcemia strongly correlates with a profound inflammatory response in COVID‐19 patients. This case corroborates the cytokine/PTH hypothesis. This patient had a high PTH sampled near the reimplanted gland but an inappropriately normal PTH from the nonimplanted arm, indicating that direct viral interaction interfering with PTH release is an unlikely mechanism. This case represents a scenario where PTH can be sampled directly from the source and this type of model could aid in the process of determining the etiology of hypocalcemia in COVID‐19.

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Glucocorticoid-Induced Hypocalcemia in a Patient with Established Hypoparathyroidism

Cited by 4 publications

References 8 publications

Postoperative Hypocalcemia following Non-Cardiac Surgical Procedures in Children with 22q11.2 Deletion Syndrome

Postoperative Hypocalcemia following Non-Cardiac Surgical Procedures in Children with 22q11.2 Deletion Syndrome

Prednisolone

COVID‐19‐Induced Refractory Symptomatic Hypocalcemia in a Patient With Parathyroid Gland Reimplantation

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