Endocrine Abstracts

We report a 45-year-old man who developed acquired primary hypoparathyroidism based on a low serum adjusted calcium level and low parathyroid hormone level. His past medical history included recurrent chronic anaemia requiring multiple transfusions since 2011. He was an ex- intravenous drug user, and suffered from chronic bilateral venous leg ulcers, and liver cirrhosis following Hepatitis C infection. Despite using doses of up to 8 mcg Calcitriol daily, his calcium levels fell recurrently and he required repeated intravenous calcium infusions. Vitamin D levels were replete, as were Magnesium levels corrected as best possible (> 0.50 mol/l) using supplements and Amiloride (24 hour urine magnesium was 0.93 mmol/L). He was not on a proton pump inhibitor. Finally, Teriparatide 40mcg was added to a combination of Calcitriol 2.5 μg, calcium carbonate 10 mg, Adcal D₃, colecaciferol 800 units, magnesium aspartate 13 g, and Amiloride 20 mg daily. Yet, recurrent hypocalcaemia continued to occur requiring Infusions almost twice weekly. With regards to the recurrent chronic anaemia, he has been extensively investigated by haematology and gastroenterology colleagues, with no cause found. However, his Ferritin levels averaged around 30 ng/ml, suggesting blood loss and iron deficiency as the cause. We looked into the possible theory of exposure to citrate from multiple bloods transfusions as a cause of hypocalcaemia. But an avoidance of blood transfusions for 2 weeks did not prevent hypocalcaemia. Compliance with medications was questioned repeatedly with both the patient and nurses during his prolonged admission. Directly observed therapy for all his medication was carried out. With this, we were able to maintain calcium levels above the acceptable range and the patient did not require intravenous calcium replacement for 3 months. Non-compliance with medication poses a challenge in managing chronic conditions. Supervised treatment should be considered in situations where conventional treatment does not yield results.