Endocrine Abstracts

Introduction: There is a risk of hypercalcemia, nephrolithiasis, nephrocalsinosis, and renal failure in the treatment of hypoparathyroidism. We present a case who has an improvement of this complication after changing large doses of vitamin D to physiological doses of 1,25(OH)₂D itself.

Case report: A 50 years old man was admitted to hospital. He had idiopathic hypoparatyhroidism from the age of 24. He was using oral 1,25(OH)₂D 0.25 μg, 1333 IU Vit D, and 2500 mg calcium carbonate and also 880 IU Vit D₃/day.

Physical examination was normal. Laboratory tests were revealed the serum creatinine as 1.3 mg/dl but serum calcium was 7.6 mg/dl and serum phosphorus was 5 mg/dl. Renal US confirmed medullary nephrocalcinosis.

The therapy was changed to 1,25(OH)₂D 0.25 μg 2×1/day and and 2500 mg calcium carbonate and also 880 IU Vit D₃/day.We followed serum calcium and phosphorus for monthly, serum creatinine for every 3 month and renal USG for every 6 month.

After 6 months of therapy, serum calcium was 8.8 mg/dl, serum phosphorus was 4.1 mg/dl, and serum creatinine was 1.3 but surprisingly renal US showed an important improvement in sonographic appearance of medullary calcinosis.

Conclusion: Some literature suggests the use of injectable PTH(1–34) for this complication. However, PTH is not approved by FDA for use in hypoparathyroidism in USA because of the unknown risk of osteosarcoma. In Turkey we can only use as a drug except of indication with the permission of Health Ministry.

In this case; changing the therapy to physiological doses of 1,25(OH)₂D and adding elementary calcium a dose for maintaining serum calcium level near the lower limit of normal reference values a degree of some improvement was provided.