scholarly journals Thiazide Treatment in Primary Hyperparathyroidism—A New Indication for an Old Medication?

2016 ◽  
Vol 102 (4) ◽  
pp. 1270-1276 ◽  
Author(s):  
Gloria Tsvetov ◽  
Dania Hirsch ◽  
Ilan Shimon ◽  
Carlos Benbassat ◽  
Hiba Masri-Iraqi ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Tertiary Hospital ◽  
Idiopathic Hypercalciuria ◽  
Urine Calcium ◽  
Before And After ◽  
Urine And Serum

Abstract Context: There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT. Objective: To test the safety and efficacy of thiazides in PHPT. Design: Retrospective analysis of medical records. Setting: Endocrine clinic at a tertiary hospital. Patients: Fourteen male and 58 female patients with PHPT treated with thiazides. Interventions: Data were compared for each patient before and after thiazide administration. Main Outcome Measures: Effect of thiazide on urine and serum calcium levels. Results: Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose. Conclusion: Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.

Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

2021 ◽  
Vol 11 (1) ◽  
pp. 4-8
Author(s):  
Amna Khan ◽  
Anila Farhat ◽  
Hamayun Anwar ◽  
Sajid Shamim ◽  
Mujeeb Ur Rehman ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
P Value ◽  
Cross Sectional ◽  
Unconjugated Hyperbilirubinemia ◽  
Before And After

Objective: To determine the frequency of hypocalcemia in neonates with unconjugated hyperbilirubinemia receivingphototherapy.Study design and setting: Cross sectional study conducted at neonatal intensive care unit, King Abdullah Teaching Hospital,Mansehra for one year from December 2017 to November 2018.Methodology: Total 213 full term stable neonates of either gender with jaundice were studied in this study. Out of which,143 with unconjugated hyperbilirubinemia were exposed to phototherapy while 70 neonates with exaggerated physiologicalhyperbilirubinemia taken as control were not exposed to phototherapy. Serum calcium level was determined through bloodtest before and after 24 hours of phototherapy. SPSS version 22 was used to analyze the data. Frequency and percentageswere used to describe categorical variables like gender and hypocalcemia. Hypocalcemia was stratified by age and genderto see effect modifiers. Post stratified chi-square test was applied in which p value = 0.05 was considered as significancevalue.Results: In study group, 143 neonates who received phototherapy had mean age of 7 days ± 2.62 SD. Total 65% neonateswere male and 35% neonates were female. Mean serum calcium level of neonates before and after provision of phototherapywas 9.28 mg/dl ± 0.23 and 8.54 mg/dl ± 0.68 respectively, which is statistically significant. The frequency of hypocalcemiawas 40% in neonates with unconjugated hyperbilirubinemia after 24 hours of phototherapy.Conclusion: Hypocalcemia is an important complication in neonates with unconjugated hyperbilirubinemia after continuousphototherapy. Hypocalcemia has clinical impact and adds to morbidity, and if left untreated, can lead to mortality.

scholarly journals An Interesting Case of Isolated Bone Marrow Sarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A180-A180
Author(s):  
Iqra Iqbal ◽  
Artem Minalyan ◽  
Muhammad Atique Alam Khan ◽  
Glenn A McGrath
Keyword(s):  
Bone Marrow ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Parathyroid Adenoma ◽  
Bone Marrow Biopsy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Vitamin D Levels ◽  
High Calcium

Abstract Introduction: About 30% cases of sarcoidosis have extrapulmonary manifestations but only 7% of patients present without any lung involvement. Among those 7%, most of the patients have manifestations on the skin but isolated bone marrow sarcoidosis has not been commonly reported. This case represents an unusual manifestation of isolated bone marrow sarcoidosis presenting with very high calcium levels. Case Presentation: A 58-year-old female presented to us with fatigue, poor appetite, and nausea. She did not report any weight changes. Her cancer screening was up to date. On examination, she appeared dehydrated. No neck swelling was appreciated. Cardiac, respiratory, abdominal, and neurological examinations were normal. Complete blood count showed hemoglobin of 10.6 mg/dL, white blood cell count of 3.8 k/dL, and platelet count of 87 x109/L. Metabolic panel revealed hypercalcemia with corrected calcium levels as high as 12.6 mg/dL. Ionized calcium was 8.1 mg/dL (normal 4.8 - 5.6). Her parathyroid hormone (PTH) level was elevated up to 64.6 mg/dL and then further increased to 134.3 mg/dL. A 24-hour urinary calcium level was normal. 1, 25-dihydroxy (1,25-OH) and 25-OH vitamin D levels were 97 mg/dL (normal 18–72) and 31.2 mg/dL, respectively. Serum protein electrophoresis and light chain analysis were normal. Hyperparathyroidism was suggested as a cause of hypercalcemia. Ultrasound of the neck and sestamibi scan showed a right lower pole parathyroid adenoma. Paraneoplastic hypercalcemia was also one of the differentials. Parathyroid hormone related peptide (PTHrP) was 9 pg/mL (normal 14 - 27). Colonoscopy was normal. Computerized tomography showed normal lungs, liver and spleen. No masses and lymphadenopathy was seen. A bone marrow biopsy was done for pancytopenia. Patient underwent parathyroid adenoma removal followed by a drop in serum calcium level (8.2 mg/dL). Patient was discharged on calcium carbonate and vitamin D tablets. Upon outpatient follow-up, calcium level started to rise again up to 9.8 mg/dL. Despite discontinuation of supplemental calcium and vitamin D, calcium continued to uptrend (11.5 mg/dL 4 weeks later). Angiotensin converting enzyme (ACE) level came back as high as 129 (normal level < 40 mcg/L). Meanwhile, the bone marrow biopsy results showed that 40% of bone marrow was occupied by non-caseating granulomas suggesting sarcoidosis. Patient was started on steroids for isolated bone marrow sarcoidosis, and eventually her serum calcium level normalized. Conclusion: An isolated bone marrow sarcoidosis is an extremely rare manifestation of extrapulmonary sarcoidosis. It can present with pancytopenia and should be sought in patients with persistent hypercalcemia. In addition, our case was challenging due to the presence of a concurrent hyperparathyroidism which was initially thought to be the only explanation of our patient’s hypercalcemia.

scholarly journals Comparative Evaluation of Serum Calcium and Magnesium Level in Preeclamptic and NonPreeclamptic Women in a Tertiary Hospital in Southern Nigeria

2018 ◽  
Vol 14 (12) ◽  
pp. 437
Author(s):  
Allagoa DO. ◽  
Agbo OJ. ◽  
Orluwene CG.
Keyword(s):  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Serum Magnesium ◽  
Serum Levels ◽  
Tertiary Hospital ◽  
Magnesium Level ◽  
P Value ◽  
Serum Magnesium Level ◽  
Calcium And Magnesium

Background: Calcium and magnesium are two micronutrients whose role in the development of preeclampsia has been investigated over the years. There is paucity of studies on the role of serum levels of calcium and magnesium in the development of preeclampsia in south-south Nigeria. Objective: Our study evaluated the serum level of calcium and magnesium in preeclamptic and non preeclamptic women in a Tertiary Hospital in southsouth Nigeria. Methodology: We carried out a comparative study in which 52 preeclamptic and 52 non preeclamptic women, who satisfied the eligibility criteria, were enrolled for the study. Data entry and statistical analysis was done using statistical software (IBM SPSS® for windows version 21.0). Data were analyzed for mean and standard deviation. Comparison of serum levels of elements between the two groups was performed by student t-test, and P value < 0.05 was considered as statistically significant. Results: The serum calcium level was statistically lower in the women who developed preeclampsia compared to those who did not (8.37±0.91 mg/dl vs 9.33±1.15mg/dl, p<0.001). The serum magnesium level was not statistically different between women who had preeclampsia and those who did not (1.79±0.24mg/dl vs 1.88±0.37mg/dl, p = 0.102). The systolic and diastolic blood pressure showed a significant negative correlation with serum calcium level, unlike serum magnesiun level in those that had preeclampsia. Conclusion: This study showed that women who developed preeclampsia demonstrated reduced serum calcium level and no reduction in serum magnesium level. This study support the hypothesis that hypocalcaemia, unlike hypomagnecaemia, is a possible aetiology of preeclampsia.

scholarly journals Study of prevalence of secondary hyperparathyroidism in chronic renal failure in hadoti region

2019 ◽  
Vol 7 (8) ◽  
pp. 2903
Author(s):  
Chiranjee Lal Dayma ◽  
Devendra Ajmera ◽  
Shiv Charan Jelia ◽  
Pankaj Jain
Keyword(s):  
Renal Failure ◽  
Parathyroid Hormone ◽  
Chronic Renal Failure ◽  
Secondary Hyperparathyroidism ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Hormone Level ◽  
Serum Parathyroid Hormone ◽  
The Difference

Background: Secondary hyperparathyroidism is known and early complication of chronic renal failure patients. Aim of this study was to assess the prevalence of secondary hyperparathyroidism and correlation between serum parathyroid hormone level with biochemical parameters in renal failure patients in tertiary care hospital in Kota, Rajasthan.Methods: A cross sectional observational study was carried out in 50 patients who had creatinine clearance of 30ml/min/1.73m2 or less for greater than 6 weeks attended the OPD of department of General Medicine, New Medical College hospital, Kota, Rajasthan from May 2018 to November 2018. Investigations like complete blood count, renal function test, urine routine microscopy and USG abdomen with serum parathyroid hormone, serum phosphorus, serum calcium levels were done. Serum parathyroid hormone level was done by calorimetric method.Results: The prevalence of secondary hyperparathyroidism in our study was 72%.In hyperparathyroidism patient’s serum calcium level was low and the difference was highly significant (p<0.001). There is negative correlation between S.PTH and S. calcium level (r=-0.536). Mean serum calcium level in our study is 1.6mmol/l. In hyperparathyroidism patient’s serum phosphate level was high and the difference was highly significant (p<0.001). There was positive correlation between S.PTH and S.PO4 level (r=0.402). Mean serum phosphorus level in our study is 5.7 mg/dl. Prevalence of hyperparathyroidism was high among CRF patients with normal BP than hypertensive patients and with normal sugar than diabetics but the difference in proportion was not significant (p=0.87, p=0.98 respectively). 90% patients were on haemodialysis while 10% patients were on conservative management.Conclusions: Early detection of secondary hyperparathyroidism in chronic renal failure patients can reduce its complications like bone fracture and cardiovascular complications.

Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amna Khan ◽  
Anila Farhat ◽  
Hamayun Anwar ◽  
Sajid Shamim ◽  
Mujeeb Ur Rehman ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
P Value ◽  
Cross Sectional ◽  
Unconjugated Hyperbilirubinemia ◽  
Before And After

Objective: To determine the frequency of hypocalcemia in neonates with unconjugated hyperbilirubinemia receivingphototherapy.Study design and setting: Cross sectional study conducted at neonatal intensive care unit, King Abdullah Teaching Hospital,Mansehra for one year from December 2017 to November 2018.Methodology: Total 213 full term stable neonates of either gender with jaundice were studied in this study. Out of which,143 with unconjugated hyperbilirubinemia were exposed to phototherapy while 70 neonates with exaggerated physiologicalhyperbilirubinemia taken as control were not exposed to phototherapy. Serum calcium level was determined through bloodtest before and after 24 hours of phototherapy. SPSS version 22 was used to analyze the data. Frequency and percentageswere used to describe categorical variables like gender and hypocalcemia. Hypocalcemia was stratified by age and genderto see effect modifiers. Post stratified chi-square test was applied in which p value = 0.05 was considered as significancevalue.Results: In study group, 143 neonates who received phototherapy had mean age of 7 days ± 2.62 SD. Total 65% neonateswere male and 35% neonates were female. Mean serum calcium level of neonates before and after provision of phototherapywas 9.28 mg/dl ± 0.23 and 8.54 mg/dl ± 0.68 respectively, which is statistically significant. The frequency of hypocalcemiawas 40% in neonates with unconjugated hyperbilirubinemia after 24 hours of phototherapy.Conclusion: Hypocalcemia is an important complication in neonates with unconjugated hyperbilirubinemia after continuousphototherapy. Hypocalcemia has clinical impact and adds to morbidity, and if left untreated, can lead to mortality.

scholarly journals The effect of phototherapy on serum calcium level in neonates with hyperbilirubinemia: a cross sectional study

2020 ◽  
Vol 7 (8) ◽  
pp. 1772
Author(s):  
Anjali Vasant Kale ◽  
Pranoti Uttam Jadhao ◽  
Aashna Valecha ◽  
Sreelekha Kethepalli
Keyword(s):  
Standard Deviation ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Cross Sectional Study ◽  
Water Soluble ◽  
Neonatal Hyperbilirubinemia ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Before And After

Background: Neonatal Hyperbilirubinemia is one of the leading causes for admission in NICU in the first week of life. This condition if left untreated may lead to irreversible neurological damage hence increasing mortality and morbidity in newborns. Neonatal Hyperbilirubinemia is treated with phototherapy which employs blue wavelengths of light to change unconjugated bilirubin in the skin. The bilirubin is then converted to less toxic water-soluble photo-isomers that are excreted in the bile and urine. There are several toxic effects to the use of this treatment, one of them being hypocalcemia.Methods: This study has been done at Mahatma Gandhi Institute of Medical Sciences in 2016-2018 on 100 new-borns to prove the effect of phototherapy on serum calcium levels in neonates with hyperbilirubinemia. New-born who were admitted in NICU for Hyperbilirubinemia were screened according to inclusion and exclusion criteria, their sample for serum calcium and serum bilirubin levels were taken as pre and post phototherapy samples.Results: It was observed that the mean Serum calcium level before phototherapy in neonates was 9.31 mg/dl with standard deviation of 0.69 mg/dl. Whereas after phototherapy mean serum calcium level in neonates was 8.88 mg/dl with standard deviation of 0.73 mg/dl. There was statistically significant mean difference in serum calcium level at before and after phototherapy in neonates (p<0.0001).Conclusions: This study proves the hypothesis that phototherapy can cause hypocalcemia in neonates with hyperbilirubinemia.

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