Endocrine Abstracts

Some hypoparathyroid women report the appearance or intensification of hypocalcemia symptoms at the time of menses. It is still unknown whether this is the result of premenstrual syndrome or fluctuations in serum calcium levels. Studies have not found a relationship between fluctuations in levels of sex hormones and serum calcium and phosphorus and it appears probable that they affect neuromuscular excitability through a separate mechanism. Alterations in serum calcium levels during the menstrual cycle are not always detected [Graham WP.; Gordan GS.; Loken HF.; Blum A; Halden A (1964). Effect of Pregnancy and of the Menstrual Cycle on Hypoparathyroidism. The Journal of Clinical Endocrinology & Metabolism, 24(6), 512–516. doi:10.1210/jcem-24-6-512. Saha S, Goswami R. Menstruation associated hypocalcemic symptoms and serum calcium in patients with idiopathic hypoparathyroidism. BMC Endocr Disord. 2014 Mar 21;14:28. doi: 10.1186/1472-6823-14-28.]. But in some patients menses-associated hypocalcemic symptoms correlate with a decline of serum calcium [L. E. Mallette. Case Report: Hypoparathyroidism with Menses-Associated Hypocalcemia Am J Med Sci 1992; 304(1):32-37]. I have studied two patients with chronic postoperative hypoparathyroidism who have experienced muscle stiffness, numbness and paresthesia chiefly during menses. It was accompanied with the significant decline (0.20-0.38 mmol/l) of albumin-adjusted calcium levels after onset of menses.

Case 1. Patient B, 18-year-old. An improvement in well-being during menses has been achieved with an increase in the calcium supplementation dose by 500 mg and alfacalcidol by 0.5 mg. The patient was recommended to increase the dose of calcium and alfacalcidol from the 2nd to the 7th day of menses.

Case 2. Patient D, 36-year-old. Patient was prescribed oral contraceptive in the 63/7 regime, and the hypocalcemic symptoms significantly decreased, the level of serum calcium remained stable. Further research is required to determine the mechanism of serum calcium decline and the possible effect of sex hormones on symptoms of hypocalcemia in chronic hypoparathyroidism.