vitamin-d-2 and Hypocalcemia

In chronic kidney disease patients, active vitamin D level progressively declines in the course of the disease. This phenomenon is accompanied by elevation of parathyroid hormone, resulting in secondary hyperparathyroidism (SHPT), increased phosphorus levels, and hypocalcemia. All these disorders are associated with high rates of cardiovascular morbidity and mortality in these patients. Many vitamin D analogs have been approved for the treatment of SHPT in renal patients. Currently, new and more selective vitamin D receptor activators (VDRAs) have been introduced in this therapy with the aim of reducing SHPT without the hypercalcemia and hyperphosphatemia associated with the use of nonselective VDRAs. In addition, amelioration in hypertension, albuminuria, insulin resistance, and inflammation have been suggested as consequences of vitamin D receptor (VDR) activation. In this work, we summarize the beneficial effects attributed to paricalcitol, the only selective, new generation VDRA, currently available in Europe and the USA, with proven efficacy in the control of SHPT both in hemodialysis (HD) and pre-dialysis patients. Paricalcitol exerts less calcemic and phosphatemic effects than other VDRAs and prevents deleterious bone resorption. Moreover, paricalcitol-based therapy has been related to beneficial effects that could favor survival rates in chronic kidney disease patients. These benefits include anti-inflammatory and antithrombotic effects, the inhibition of vascular smooth muscle cell proliferation, the reninangiotensin system, vascular calcification, and regression of left ventricular hypertrophy, which could reduce the risk of cardiovascular mortality.

Topics: Cardiovascular Diseases; Ergocalciferols; Humans; Hyperparathyroidism; Hypocalcemia; Parathyroid Hormone; Phosphorus; Receptors, Calcitriol; Renal Insufficiency, Chronic; Treatment Outcome; Vitamin D

The involvement of vitamin D deficiency in cardiovascular morbidity and mortality is attracting great interest. In patients with chronic kidney disease this association is stronger because vitamin D levels decrease as a result of renal progressive impairment. In chronic kidney disease secondary hyperparathyroidism commonly occurs in response to persistent hypocalcemia and hyperphosphatemia; moreover, parathyroid gland volume increases, vascular calcification is accelerated, and structural and functional modifications of the left ventricle are observed. These alterations entail both cardiac and renal involvement, resulting in cardio-renal syndrome. Recent studies concluded that vitamin D administration seems to have cardioprotective and renoprotective effects and improve peripheral vascular disease, vascular calcification, cardiac outcome, and blood pressure control. In clinical practice, therefore, the use of this hormone may play an important role in cardio-renal syndrome prevention.

Topics: Cardio-Renal Syndrome; Ergocalciferols; Humans; Hyperparathyroidism, Secondary; Hyperphosphatemia; Hypocalcemia; Kidney; Parathyroid Glands; Parathyroid Hormone; Receptors, Calcitriol; Renal Insufficiency, Chronic; Vascular Calcification; Vitamin D; Vitamin D Deficiency

Recent evidence suggests that the traditional syndromes known as renal osteodystrophy, secondary hyperparathyroidism, and vitamin D deficiency are related to mortality in persons with moderate to advanced chronic kidney disease (CKD). The so-called 'kidney bone disease', also known as 'mineral and bone disorders', is defined to include bone disorders, mineral disarrays, and vascular calcification. We have identified 14 common and clinically relevant conditions of contemporary nature that are related to the kidney bone disease, including calcitriol (active vitamin D) deficiency, 25(OH)-vitamin D deficiency, biochemical hyperparathyroidism, relatively low parathyroid hormone (PTH) level, increased serum alkaline phosphatase (hyperphosphatasemia), elevated fibroblast growth factor (FGF)-23, high turnover bone disease, adynamic bone disease, uremic osteoporosis, vascular calcification, hyper- and hypophosphatemia, and hyper- and hypocalcemia. We present a critical review of these 14 conditions with emphasis on patient survival and other pertinent clinical outcomes. We also review unresolved controversies surrounding the management of these conditions by administration of nutritional vitamin D (ergocalciferol and cholecalciferol), vitamin D receptor activators (calcitriol, alphacalcidiol, doxercalciferol), D-mimetics (paricalcitol, maxacalcitol), calcimimetics (cinacalcet), recombinant PTH (teriparatide), and receptor activator of nuclear factor-kappaB ligand modulators (denosumab); compare mortality predictability of PTH and alkaline phosphatase; and examine potential risks of bone disorders and mineral disarrays in CKD patients.

Topics: Alkaline Phosphatase; Calcinosis; Calcitriol; Chronic Kidney Disease-Mineral and Bone Disorder; Ergocalciferols; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Humans; Hypercalcemia; Hyperparathyroidism, Secondary; Hyperphosphatemia; Hypocalcemia; Hypophosphatemia; Kidney Failure, Chronic; Minerals; Osteoporosis; Parathyroid Hormone; Receptors, Calcitriol; Vitamin D; Vitamin D Deficiency

Secondary hyperparathyroidism (SHPT) is common in chronic kidney disease (CKD) patients. Classically, SHPT is induced by hypocalcemia, hyperphosphatemia, and calcitriol deficiency, that cause not only renal osteodystrophy but also systemic toxicity, particularly cardiovascular disease.. Treatment with calcitriol, the active form of vitamin D, reduces serum parathyroid hormone (PTH) levels but may result in both hypercalcemia and hyperphosphatemia, increasing the risk of vascular calcification in CKD. Are the new vitamin D receptor activators (VDRAs) more useful in the treatment of SHPT for their reduced risk of hypercalcemia and hyperphosphatemia in haemodialysis (HD) patients?. In this review, we describe the new VDRA, paricalcitol (1,25-dihydroxy-19-nor-vitamin D2), which suppresses PTH secretion with minimal increases on serum calcium and phosphate levels.. In some animal models of CKD paricalcitol does not cause vascular calcification, while other VDRAs do. These data may account for the results seen in observational studies of HD patients, in which paricalcitol is associated with improved survival compared to calcitriol.

Topics: Animals; Bone Density Conservation Agents; Calcitriol; Ergocalciferols; Humans; Hyperparathyroidism, Secondary; Hyperphosphatemia; Hypocalcemia; Kidney Failure, Chronic; Receptors, Calcitriol; Renal Dialysis

Topics: Biomarkers; Chromatography, High Pressure Liquid; Diagnosis, Differential; Ergocalciferols; Humans; Hypercalcemia; Hypocalcemia; Osteomalacia; Phosphorus Metabolism Disorders; Reference Values; Rickets; Specimen Handling; Vitamin D

Animal-experimental examinations show that the peroral or intramuscular application of a high dose of vitamin D2 or of D3 leads to a toxic effect of these compounds on the osteocytes and that the hypercalcaemia evoked by this is mainly to be traced back to an increased deliberation of calcium from the bones. After application of a larger dose of vitamin D the activation mechanism in the liver and in the kidneys is much inhibited for several weeks so that no formation of 1,25-hydroxy-vitamin-D takes place; consequently, no furthering effect on the mineralisation of the bones is performed. Therefore, it is recommended to use physiological doses in the prevention of rachitis (500-1,000 IU a day). During the pregnancy the activity of the enzymes which participate in the activation of the D-vitamins increases in the liver and the kidneys. The kidneys of the fetuses are able to form 1,25-hydroxy-vitamin-D. Vitamin D and 25-hydroxy-vitamin-D transgress through the placenta into the fetuses. Due to the adaptation mentioned and the increased formation of 1,25-hydroxy-vitamin-D the absorption of calcium and phosphate increases during pregnancy. Recent pathobiochemical knowledge concerning the metabolism of the D-vitamins in several diseases are described.

Topics: Bone and Bones; Calcium; Cholecalciferol; Ergocalciferols; Female; Glomerular Filtration Rate; Humans; Hypocalcemia; Infant, Newborn; Infant, Premature, Diseases; Intestinal Absorption; Liver; Osteogenesis; Osteoporosis; Parathyroid Hormone; Phosphates; Pregnancy; Rickets; Skin; Vitamin D

Topics: Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Ergocalciferols; Feedback; Humans; Hypocalcemia; Kidney Diseases; Liver; Osteomalacia; Parathyroid Hormone; Rickets; Seasons; Ultraviolet Rays; Vitamin D

Topics: Adolescent; Adult; Anticonvulsants; Child; Child, Preschool; Clinical Trials as Topic; Ergocalciferols; Humans; Hypocalcemia; Intestinal Absorption; Long-Term Care; Placebos; Rickets; Vitamin D

Topics: Adolescent; Adult; Alkaline Phosphatase; Asia; Calcium; Clinical Enzyme Tests; England; Ergocalciferols; Female; Humans; Hypercalcemia; Hypocalcemia; Male; Osteomalacia; Parathyroid Glands; Parathyroid Hormone; Pregnancy; Pregnancy Complications; Rickets; Vitamin D Deficiency

Topics: Bone Diseases; Calcinosis; Chronic Kidney Disease-Mineral and Bone Disorder; Diet Therapy; Ergocalciferols; Fibrous Dysplasia of Bone; Fractures, Spontaneous; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Kidney Transplantation; Metabolic Diseases; Osteomalacia; Osteosclerosis; Parathyroid Glands; Phosphates; Renal Dialysis; Tendon Injuries; Vitamin D

Topics: Adenoma; Alkaline Phosphatase; Calcitonin; Calcium; Dihydrotachysterol; Diuretics; Ergocalciferols; Female; Homeostasis; Humans; Hydroxyproline; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Osteitis Deformans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Phosphates; Sulfonamides; Thiadiazines

Topics: Calcium; Calcium, Dietary; Ergocalciferols; Gluconates; Humans; Hypocalcemia; Hypoparathyroidism; Postoperative Complications; Postoperative Period; Tetany

To define the relationship between vitamin D deficiency and fibromyalgia syndrome.. This is a prospective cohort study for description of a medical disorder. The study was carried out in Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia from May 2007 to March 2010. One hundred women suffering from fibromyalgia syndrome were included. Blood level of 25-hydroxyvitamin D [25(OH) D] was estimated at initial visit and every 4 weeks until its level exceeded 50 ng/mL. The patients with vitamin D deficiency were treated with ergocalciferol 50,000 IU once weekly until their blood level of 25(OH) D exceeded 50 ng/mL. The number of tender points and the revised Fibromyalgia Impact Questionnaire (FIQR) score were used to assess the fibromyalgia before and after vitamin D repletion.. Among the 100 fibromyalgia women, there were 61 women with 25(OH) D deficiency; with vitamin D supplementation, only 42 women showed a significant improvement when their blood level of 25(OH) D became>or=30 ng/mL, this improvement became more significant when their blood level of 25(OH) D exceeded 50 ng/ mL.. Vitamin D deficiency has to be considered in the management of fibromyalgia syndrome.

Topics: Adult; Bone Density Conservation Agents; Ergocalciferols; Female; Fibromyalgia; Humans; Hypocalcemia; Middle Aged; Prospective Studies; Surveys and Questionnaires; Vitamin D; Vitamin D Deficiency

Paricalcitol is a vitamin D analog approved for the prevention and treatment of secondary hyperparathyroidism associated with chronic renal failure. This study was designed to evaluate the long-term efficacy and safety of paricalcitol. Additional analysis evaluated the effects of paricalcitol in hypocalcemic and hyperphosphatemic subpopulations.. One hundred sixty-four end-stage renal disease (ESRD) patiesnts on hemodialysis were treated in an open-label, multicenter study lasting up to 13 months in duration. After a baseline or washout period, an initial starting dose of 0.04-0.393 microg/kg was given 2-3 times per week. This dose was adjusted at the discretion of the investigator according to the patient's intact parathyroid hormone level (iPTH), calcium level, and calcium-phosphorus (Ca x P) product. The therapy was intended to reproduce expected clinical use of paricalcitol. Patients represented a wide cross-section of the ESRD population, and were not excluded from the study based on age or underlying disease.. The mean paricalcitol dose level throughout the study was 0.10 microg/kg. The mean iPTH levels (baseline mean 628.3 +/- 27.65 pg/ml) decreased rapidly during the first 4 months of therapy, and reached the designated target range (100-300 pg/ml) by month 5 (mean 295.3 +/- 25.69 pg/ml). A maximum mean decrease in iPTH level of 409 +/- 35.01 pg/ml was seen at month 13. Throughout the course of the study, the mean normalized calcium level was maintained well within the normal range (9.44-9.94 mg/dl). The mean phosphorus level was maintained in an acceptable range throughout the study (5.92-6.53 mg/dl). Mean Ca x P product was maintained between 52 and 65. Mean alkaline phosphatase levels decreased significantly from baseline with a maximum mean decrease of 62 +/- 17.3 U/l observed at month 9. In 34 initially hypocalcemic patients (mean of 7.7 mg/dl) iPTH levels decreased from baseline, on average, by 443 +/- 81.86 pg/ml while mean calcium levels rose by 1.2 +/- 0.23 mg/dl to reach the normal range. In 35 initially hyperphosphatemic patients (mean of 8.0 mg/dl) iPTH levels decreased, on average, by 515 +/- 103.31 pg/ml with an associated mean decrease in phosphorus of 0.57 +/- 0.52 mg/dl. Adverse events that were considered by the investigator to have a possible. probable, or definite relationship to study drug occurred in 26% of patients. Other than expected temporary effects of hypercalcemia and hyperphosphatemia. the only possible trends for causally-related adverse events were for nausea/vomiting and metallic taste.. This long-term study of paricalcitol demonstrates that it rapidly and effectively suppresses iPTH levels in a wide spectrum of ESRD patients and caused no unexpected adverse events.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Calcium; Ergocalciferols; Female; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Nausea; Parathyroid Hormone; Phosphorus; Taste Disorders; Time Factors; Vomiting

Topics: Adolescent; Adult; Anticonvulsants; Child; Child, Preschool; Clinical Trials as Topic; Ergocalciferols; Humans; Hypocalcemia; Intestinal Absorption; Long-Term Care; Placebos; Rickets; Vitamin D

Sixty-three men and 23 women who had undergone partial gastrectomy for ulcer disease were randomized into three groups to study the effect of calcium (2 g per day) and calcium + vitamin D2 (1000 IU calciferol per day) treatment for eight months on bone mineral. The Americium-241 gamma ray attenuation method was used to measure the changes in bone mineral density. Calcium and calcium + vitamin D2 increased the bone mineral density statistically significantly in the males, but not in females. Partial gastrectomy causes bone rarefaction, and consequently these patients reach the risk level of bone mineral density for osteoporotic fractures earlier than healthy subjects. The conclusion drawn was that prophylactic treatment is needed after partial gastrectomy. Further study is required, especially of women, to find the most suitable form of treatment for disturbances in bone mineral metabolism after gastric resection.

Topics: Aged; Bone and Bones; Calcium; Duodenum; Ergocalciferols; Female; Gastrectomy; Humans; Hypocalcemia; Jejunum; Male; Middle Aged; Minerals; Peptic Ulcer; Sex Factors; Stimulation, Chemical; Vitamin D Deficiency

Topics: Adult; Alkaline Phosphatase; Anticonvulsants; Calcium; Clinical Trials as Topic; Epilepsy; Ergocalciferols; Female; Humans; Hydroxycholecalciferols; Hypocalcemia; Isoenzymes; Male; Phenobarbital; Phenytoin; Phosphates; Serum Albumin; Sunlight; Time Factors; Vitamin D

Acute onset of quadriplegia is a rare phenomenon seen with hypocalcemia due to hypoparathyroidism. We describe a 33-year gentleman who presented with weakness of all four limbs and areflexia. ECG showed QT abnormality. Nerve conduction study revealed normal sensory and significantly low motor CMAP amplitudes in both the upper and lower extremities. This nerve conduction study can be seen in acute motor neuropathy of various etiologies, among which GBS is the most worrisome. Our patient found to have low calcium and parathyroid hormone level. His symptoms improved after calcium replacement. Occurrence of quadriplegia in hypoparathyroidism, and its improvement after correction of calcium, suggests crucial role of calcium in neuromuscular transmission. One should suspect electrolyte imbalance, like hypocalcemia in patients presenting with nerve conduction features of AMAN variant of GBS.

Topics: Adult; Calcium Gluconate; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Male; Neural Conduction; Peripheral Nerves; Quadriplegia

A 50-year-old man with a history of prostate cancer with extensive bone metastasis and hypocalcaemia presented with muscle aches and cramps. Physical exam was significant for Chvostek's and Trousseau's sign. Laboratory assessment was consistent with profound hypocalcaemia. This was believed to be due to hungry bone syndrome secondary to advanced prostate cancer. He was treated with intravenous calcium, vitamin D and calcitriol. He also received three doses of radium

Topics: Antineoplastic Agents; Bone Density Conservation Agents; Bone Diseases, Metabolic; Bone Neoplasms; Calcium Carbonate; Ergocalciferols; Humans; Hypocalcemia; Male; Middle Aged; Prostatic Neoplasms; Radioisotopes; Radium; Whole Body Imaging

Options for chronic treatment of hypoparathyroidism include calcitriol, recombinant human parathyroid hormone, and high-dose vitamin D (D2). D2 is used in a minority of patients because of fear of prolonged hypercalcemia and renal toxicity. There is a paucity of recent data about D2 use in hypoparathyroidism.. Compare renal function, hypercalcemia, and hypocalcemia in patients with hypoparathyroidism treated chronically with either D2 (D2 group) or calcitriol.. A retrospective study of patients with hypoparathyroidism treated at the University of Maryland Hospital. Participants were identified by a billing record search with diagnosis confirmed by chart review. Thirty patients were identified; 16 were treated chronically with D2, 14 with calcitriol. Data were extracted from medical records.. Serum creatinine and calcium, hospitalizations, and emergency department (ED) visits for hypercalcemia and hypocalcemia.. D2 and calcitriol groups were similar in age (58.9 ± 16.7 vs 50.9 ± 22.6 years, P = 0.28), sex, and treatment duration (17.8 ± 14.2 vs 8.5 ± 4.4 years, P = 0.076). Hospitalization or ED visits for hypocalcemia occurred in none of the D2 group vs four of 14 in the calcitriol group (P = 0.03); three in the calcitriol group had multiple ED visits. There were no differences between D2 and calcitriol groups in hospitalizations or ED visits for hypercalcemia, serum creatinine or calcium, or kidney stones.. We found less morbidity from hypocalcemia in hypoparathyroid patients treated chronically with D2 compared with calcitriol and found no difference in renal function or morbidity from hypercalcemia. Treatment with D2 should be considered in patients with hypoparathyroidism, particularly in those who experience recurrent hypocalcemia.

Topics: Adult; Aged; Calcitriol; Calcium; Creatinine; Emergency Service, Hospital; Ergocalciferols; Female; Hospitalization; Humans; Hypercalcemia; Hypocalcemia; Hypoparathyroidism; Kidney Calculi; Male; Middle Aged; Nephrocalcinosis; Renal Insufficiency; Retrospective Studies; Vitamins

Ipilimumab (a monoclonal antibody against CTLA-4) and nivolumab (a humanized antibody against PD-1) target these immune checkpoint pathways and are used for treatment of melanoma and an increasing number of other cancers. However, they may cause immune-related adverse effects (IRAEs). Although many endocrinopathies are known to be IRAEs, primary hypoparathyroidism with severe hypocalcemia has never been reported. This is the first case of hypoparathyroidism as an IRAE presenting to an Emergency Department with acute hypocalcemia.. A 73-year-old man with metastatic melanoma presented to the Emergency Department for the chief complaints of imbalance, general muscle weakness, abdominal pain and tingling in extremities. He had wide spread metastasis, and begun immunotherapy with concurrent ipilimumab and nivolumab 1.5months ago. At presentation, he had ataxia, paresthesia in the hands and feet, and abdominal cramping. Magnetic resonance imaging of the brain was unremarkable. He was found to be hypocalcemic with undetectable plasma parathyroid hormone. He was admitted for treatment of symptomatic hypocalcemia and was diagnosed with primary hypoparathyroidism. Shortly afterwards, he had thyrotoxicosis manifesting as tachycardia and anxiety, followed by development of primary hypothyroidism. At 4months after the Emergency Department visit, his parathyroid function and thyroid function had not recovered, and required continued thyroid hormone replacement and calcium and vitamin D treatment for hypocalcemia.. Primary hypoparathyroidism caused by ipilimumab and nivolumab may acute manifest with severe symptomatic hypocalcemia. Emergency care providers should be aware of hypoparathyroidism as a new IRAE in this new era of immuno-oncology.

Topics: Aged; Antibodies, Monoclonal; Calcium Gluconate; Ergocalciferols; Hormone Replacement Therapy; Humans; Hypocalcemia; Hypoparathyroidism; Immunotherapy; Magnesium Sulfate; Male; Melanoma; Treatment Outcome; Vitamins

Topics: Calcitriol; Calcium; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Vitamin D

Topics: Calcitriol; Calcium; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Vitamin D

Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

Topics: Calcium Compounds; Carcinoma, Papillary; Ergocalciferols; Female; Gastric Bypass; Humans; Hypocalcemia; Middle Aged; Risk Factors; Thyroid Neoplasms; Thyroidectomy; Vitamins

The relationships among cortical volumetric bone mineral density (CortBMD) and comprehensive measures of mineral metabolism have not been addressed in chronic kidney disease (CKD).. The aim of the study was to identify the determinants of CortBMD in childhood CKD. A secondary objective was to assess whether CortBMD was associated with subsequent fracture.. This prospective cohort study included 171 children, adolescents, and young adults (aged 5-21 years) with CKD stages 2-5D at enrollment and 89 1 year later.. Serum measures included vitamin D [25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D (1,25(OH)₂D), 24,25-dihydroxyvitamin D], vitamin D-binding protein, intact PTH, fibroblast growth factor 23, calcium, and phosphorus. Tibia quantitative computed tomography measures of CortBMD were expressed as sex-, race-, and age-specific Z-scores based on 675 controls. Multivariable linear regression identified the independent correlates of CortBMD Z-scores and the change in CortBMD Z-scores.. Lower calcium (β = .31/1 mg/dL, P = .01) and 25(OH)D (β = .18/10 ng/mL, P = .04) and higher PTH (β = -.02/10%, P = .002) and 1,25(OH)₂D (β = -.07/10%, P < .001) were independently associated with lower CortBMD Z-scores at baseline. The correlations of total, free, and bioavailable 25(OH)D with CortBMD did not differ. Higher baseline 1,25(OH)₂D (P < .05) and greater increases in PTH (P < .001) were associated with greater declines in CortBMD Z-scores. Greater increases in calcium concentrations were associated with greater increases in CortBMD Z-scores in growing children (interaction P = .009). The hazard ratio for fracture was 1.75 (95% confidence interval 1.15-2.67; P = .009) per SD lower baseline CortBMD.. Greater PTH and 1,25(OH)₂D and lower calcium concentrations were independently associated with baseline and progressive cortical deficits in childhood CKD. Lower CortBMD Z-score was associated with increased fracture risk.

Topics: Adolescent; Adolescent Development; Adult; Bone and Bones; Bone Density; Bone Development; Bone Resorption; Calcitriol; Child; Child Development; Child, Preschool; Cohort Studies; Ergocalciferols; Fractures, Bone; Humans; Hypocalcemia; Parathyroid Hormone; Prospective Studies; Renal Insufficiency, Chronic; Risk; United States; Young Adult

Pseudohypoparathyroidism type 1B (PHP1B) patients have PTH resistance at the renal proximal tubule and develop hypocalcemia and secondary hyperparathyroidism. Hyperparathyroid bone disease also develops in some patients. PHP1B patients are at theoretical risk of developing tertiary hyperparathyroidism.. Patients were studied in a clinical research center.. Five female PHP1B patients presented with hypercalcemia and elevated PTH.. Patients either underwent parathyroidectomy (n = 4) or received cinacalcet (n = 1).. Serum calcium and PTH were serially measured before and after intervention.. Five PHP1B patients developed concomitantly elevated serum calcium and PTH levels (range, 235-864 ng/liter) requiring termination of calcium and vitamin D therapy (time after diagnosis, 21-42 yr; median, 34 yr), consistent with tertiary hyperparathyroidism. Four patients underwent parathyroidectomy with removal of one (n = 2) or two (n = 2) enlarged parathyroid glands. Calcium and vitamin D therapy was reinstituted postoperatively, and at 93-month median follow-up, PTH levels ranged between 56 and 182 (normal, <87) ng/liter. One patient was treated with cinacalcet, resulting in resolution of hypercalcemia.. PHP1B patients are at risk of developing tertiary hyperparathyroidism and/or hyperparathyroid bone disease and should therefore be treated with sufficient doses of calcium and vitamin D to achieve serum calcium and PTH levels within or as close to the normal range as possible. Surgery is the treatment of choice in this setting. Cinacalcet may be a useful alternative in those who do not undergo surgery.

Topics: Adolescent; Age of Onset; Calcitriol; Calcium; Child, Preschool; Disease Progression; Ergocalciferols; Female; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Male; Middle Aged; Muscular Diseases; Osteitis Fibrosa Cystica; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Pseudohypoparathyroidism; Seizures; Syntaxin 16; Young Adult

Hypoparathyroidism and ankylosing spondylitis are two conditions with distinctive features which allow their differentiation. Hypoparathyroidism can be responsible for clinical and radiological changes resembling those seen in patients with ankylosing spondylitis. We report an exceptional case of a patient with an association between ankylosing spondylitis and a severe idiopathic hypoparathyroidism with difficulties in diagnosis. To our knowledge, this is the first case of such an occurrence.

Topics: 25-Hydroxyvitamin D3 1-alpha-Hydroxylase; Anti-Inflammatory Agents; Calcium Gluconate; Dietary Supplements; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Radiography; Severity of Illness Index; Spondylitis, Ankylosing; Tetany; Treatment Outcome

Calcimimetics activate the calcium-sensing receptor (CaR) and reduce parathyroid hormone (PTH) by increasing the sensitivity of the parathyroid CaR to ambient calcium. The calcimimetic, cinacalcet, is effective in treating secondary hyperparathyroidism in dialysis patients [chronic kidney disease (CKD 5)], but little is known about its effects on stage 3-4 CKD patients. We compared cinacalcet and paricalcitol in uremic rats with creatinine clearances "equivalent" to patients with CKD 3-4. Uremia was induced in anesthetized rats using the 5/6th nephrectomy model. Groups were 1) uremic control, 2) uremic + cinacalcet (U+Cin; 15 mg x kg(-1) x day(-1) po for 6 wk), 3) uremic + paricalcitol (U+Par; 0.16 microg/kg, 3 x wk, ip for 6 wk), and 4) normal. Unlike U+Par animals, cinacalcet promoted hypocalcemia and marked hyperphosphatemia. The Ca x P in U+Cin rats was twice that of U+Par rats. Both compounds suppressed PTH. Serum 1,25-(OH)(2)D(3) was decreased in both U+Par and U+Cin rats. Serum FGF-23 was increased in U+Par but not in U+Cin, where it tended to decrease. Analysis of tibiae showed that U+Cin, but not U+Par, rats had reduced bone volume. U+Cin rats had similar bone formation and reduced osteoid surface, but higher bone resorption. Hypocalcemia, hyperphosphatemia, low 1,25-(OH)(2)D(3), and cinacalcet itself may play a role in the detrimental effects on bone seen in U+Cin rats. This requires further investigation. In conclusion, due to its effects on bone and to the hypocalcemia and severe hyperphosphatemia it induces, we believe that cinacalcet should not be used in patients with CKD without further detailed studies.

Topics: Animals; Biomarkers; Bone Resorption; Calcitriol; Calcium; Cinacalcet; Creatinine; Disease Models, Animal; Ergocalciferols; Female; Fibroblast Growth Factors; Hyperparathyroidism; Hyperphosphatemia; Hypocalcemia; Naphthalenes; Nephrectomy; Parathyroid Hormone; Phosphorus; Rats; Rats, Sprague-Dawley; Receptors, Calcium-Sensing; Renal Insufficiency, Chronic; Severity of Illness Index; Tibia; Uremia

Topics: Animals; Biomarkers; Bone Remodeling; Bone Resorption; Calcitriol; Cinacalcet; Ergocalciferols; Fibroblast Growth Factors; Humans; Hyperparathyroidism; Hyperphosphatemia; Hypocalcemia; Naphthalenes; Parathyroid Hormone; Rats; Renal Insufficiency, Chronic; Severity of Illness Index; Tibia; Treatment Outcome; Uremia

The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time.. We employed a Cox model using up-to-5-year (7/2001-6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed.. Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml). Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22-1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group.. Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.

Topics: Adult; Aged; Black or African American; Bone Density Conservation Agents; Cause of Death; Ergocalciferols; Female; Humans; Hypercalcemia; Hypocalcemia; Kidney Failure, Chronic; Longitudinal Studies; Male; Middle Aged; Parathyroid Hormone; Predictive Value of Tests; Proportional Hazards Models; Renal Dialysis; Time Factors

Topics: Breast Feeding; Calcium Carbonate; Cranial Fontanelles; Diagnosis, Differential; Diarrhea, Infantile; Ergocalciferols; Humans; Hypocalcemia; Hypophosphatemia; Infant; Lung; Male; Radiography; Respiratory Tract Infections; Rickets; Seizures; Sickle Cell Trait; Vitamin D; Vitamin D Deficiency; Vitamins

Though hypocalcemic stridor is a well-recognized pediatric emergency, it has rarely been reported in the elderly, and hypocalcemia of nutritional origin presenting with stridor in this group has not previously been reported. We report an elderly patient who presented with stridor and intermittent sudden airway obstruction resulting from laryngospasm secondary to hypocalcemia of nutritional origin and we present a brief review of this life-threatening complication of hypocalcemia.

Topics: Aged, 80 and over; Airway Obstruction; Calcium; Calcium Gluconate; Diagnosis, Differential; Ergocalciferols; Humans; Hypocalcemia; Laryngismus; Male; Respiratory Sounds; Vitamins

Topics: Aged; Calcium; Drug Therapy, Combination; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Male; Psoriasis

Topics: Ergocalciferols; Follow-Up Studies; Humans; Hypocalcemia; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Infant, Newborn; Male; Nutritional Requirements; Risk Assessment; Sampling Studies; Seizures; Soybean Proteins; Treatment Outcome; Vitamin D Deficiency

The vitamin D receptor (VDR) is present in mammary gland, and VDR ablation is associated with accelerated glandular development during puberty. VDR is a nuclear receptor whose ligand, 1,25-dihydroxyvitamin D [1,25-(OH)(2)D] is generated after metabolic activation of vitamin D by specific vitamin D hydroxylases. In these studies, we demonstrate that both the VDR and the vitamin D 1-alpha hydroxylase (CYP27B1), which produces 1,25-(OH)(2)D are present in mammary gland and dynamically regulated during pregnancy, lactation, and involution. Furthermore, we show that mice lacking VDR exhibit accelerated lobuloalveolar development and premature casein expression during pregnancy and delayed postlactational involution compared with mice with functional VDR. The delay in mammary gland regression after weaning of VDR knockout mice is associated with impaired apoptosis as demonstrated by reductions in terminal deoxynucleotidyl transferase-mediated deoxyuridine nick-end labeling staining, caspase-3 activation and Bax induction. Under the conditions used in this study, VDR ablation was not associated with hypocalcemia, suggesting that altered mammary gland development in the absence of the VDR is not related to disturbances in calcium homeostasis. Furthermore, in the setting of normocalcemia, VDR ablation does not affect milk protein or calcium content. These studies suggest that the VDR contributes to mammary cell turnover during the reproductive cycle, and its effects may be mediated via both endocrine and autocrine signaling pathways. Unlike many mammary regulatory factors that exert transient, stage-specific effects, VDR signaling impacts on mammary gland biology during all phases of the reproductive cycle.

Topics: Animals; Apoptosis; Calcium; Caseins; Ergocalciferols; Female; Gene Expression; Hypocalcemia; Lactation; Mammary Glands, Animal; Mice; Mice, Knockout; Milk, Human; Mutation; Pregnancy; Progesterone; Prolactin; Receptors, Calcitriol; Receptors, Transforming Growth Factor beta; RNA, Messenger; Steroid Hydroxylases

Topics: Breast Feeding; Ergocalciferols; Failure to Thrive; Humans; Hypocalcemia; Infant; Infant Food; Male; Vitamin D Deficiency

A single-day large dose of vitamin D (stosstherapy) was given to 42 patients with nutritional vitamin D-deficiency rickets. Stosstherapy is safe and effective, obviates problems with compliance, and, by evoking a response in 4 to 7 days in nutritional rickets, becomes a valuable diagnostic aid for patients in whom initial findings do not clearly distinguish nutritional rickets from familial hypophosphatemic rickets.

Topics: Administration, Oral; Calcium; Capsules; Child; Child, Preschool; Drug Administration Schedule; Ergocalciferols; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Hypophosphatemia, Familial; Infant; Phosphates; Rickets; Vitamin D; Vitamin D Deficiency

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcium Carbonate; Child; Child, Preschool; Dihydrotachysterol; Ergocalciferols; Follow-Up Studies; Humans; Hypocalcemia; Hypoparathyroidism; Middle Aged; Neck Muscles; Parathyroid Glands; Phosphates; Thyroidectomy; Transplantation, Autologous

The authors report on a case of cardiomyopathy with congestive heart failure in an infant with severe hypocalcemia related to vitamin D deficient rickets. The heart failure was successfully treated with calcium gluconate and vitamin D, associated with dobutamide.

Topics: Calcium Gluconate; Cardiomyopathies; Electrocardiography; Ergocalciferols; Humans; Hypocalcemia; Infant; Male; Rickets; Vitamin D Deficiency

During the first week of life, 400 IU per day of 25(OH)D3 were given to 126 preterm and 112 full-term, small for date newborn infants, while 1000 UI per day of Vitamin D2 were given to 18 preterm and 27 full-term, small for date newborn infants, in order to compare their effectiveness for the prevention of neonatal hypocalcemia. 67 preterm and 67 full-term newborns were included in the control group. The incidence of late hypocalcemia was reduced from 16.4% to 0 in full-term babies and from 6% to 2.4% in preterm babies by the 25(OH)D3 but not by Vit. D2 administration. The incidence of early hypocalcemia was not modified at all. The Authors suggest 25(OH)D3 administration to prevent the late hypocalcemia and, together with calcium support, to treat the early hypocalcemia in the low birth weight newborn.

Topics: Calcifediol; Ergocalciferols; Humans; Hypocalcemia; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Prospective Studies

A patient treated with massive doses of vitamin D for pseudohypoparathyroidism who had a convulsive episode due to hypocalcemia is reported. Evaluation of the patient's vitamin D status led us to conclude that the patient was non-compliant with vitamin D treatment.

Topics: Adolescent; Ergocalciferols; Humans; Hypocalcemia; Male; Patient Compliance; Pseudohypoparathyroidism; Seizures

Although abnormalities of calcium and vitamin D metabolism are recognized in children with nephrotic syndrome, longitudinal observations are not available in these patients during periods of relapse and remission. We report observations in 58 children (mean age 10.1 years) with nephrotic syndrome and normal glomerular filtration rate. Hypocalcemia, modest hyperparathyroidism, and strikingly low calcidiol levels were identified during episodes of relapse. Most alterations were transient, and normalized on remission. The plasma concentration of calcitriol, the most active metabolite of vitamin D, was found to be normal in both relapse and remission. In the presence of hypocalcemia and hyperparathyroidism, however, normal plasma calcitriol levels in relapse may be inappropriately low and reflect a state of relative deficiency. Concurrent glucocorticoid therapy did not modify the results. A corollary of our observations is that children with relapsing or protracted nephrotic syndrome are at risk of developing metabolic bone disease, even without impairment of glomerular filtration rate.

Topics: 25-Hydroxyvitamin D 2; Adolescent; Adult; Calcium; Child; Child, Preschool; Ergocalciferols; Glomerular Filtration Rate; Humans; Hyperparathyroidism; Hypocalcemia; Nephrotic Syndrome; Parathyroid Hormone; Recurrence; Vitamin D

A 25-yr-old black man with cystic fibrosis and cirrhosis developed symptoms of osteomalacia and hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and low circulating 25-hydroxyvitamin D (25-OHD). Serum 1,25-dihydroxyvitamin D (1,25-[OH]2D) was within the normal range. Iliac crest bone biopsy confirmed the diagnosis of osteomalacia. Oral administration of 50,000 IU of vitamin D2 failed to relieve symptoms or raise serum 25-OHD levels to normal. Intramuscular vitamin D2, 10,000 IU every 8-12 week, improved symptoms, raised serum 25-OHD to normal, and increased circulating 1,25-[OH]2D to values five times normal. Over the next 10 mo circulating 1,25-[OH]2D remained elevated despite normalization of serum calcium, phosphorus, and parathyroid hormone. Repeat bone biopsy 1 yr after parenteral vitamin D showed healing of the osteomalacia. Malabsorption of vitamin D appears secondary to profound steatorrhea due to pancreatic insufficiency and secondary biliary cirrhosis. Although extensive hepatocellular disease was present, hepatic conversion of vitamin D to 25-OHD was intact. Both high and low circulating 1,25-[OH]2D levels during active osteomalacia have been reported; initially, the level was in the normal range and higher values in this patient occurred with repletion of 25-OHD substrate. This study shows that symptomatic osteomalacia may be a major manifestation of cystic fibrosis in those patients surviving into adulthood. Measurements of serum 25-OHD in cystic fibrosis patients may identify those who should receive supplemental vitamin D.

Topics: Adult; Bone and Bones; Calcium; Cystic Fibrosis; Ergocalciferols; Humans; Hydroxycholecalciferols; Hyperparathyroidism, Secondary; Hypocalcemia; Liver; Liver Cirrhosis; Magnesium; Malabsorption Syndromes; Male; Osteomalacia; Parathyroid Hormone; Phosphorus; Serum Albumin; Vitamin D

The effect of parenteral administration of magnesium was studied in five patients with hypomagnesaemic hypocalcaemia. The initial metabolic state was characterized by a normal level of serum immunoreactive parathyroid hormone (iPTH), and by low or undetectable serum 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25 (OH)2D). A parathyroid response was elicited by the acute intravenous injection of magnesium chloride. In contrast, 1,25(OH)2D did not change up to 24 h after the injection. Intramuscular magnesium sulphate restored serum magnesium and calcium to normal, whereas iPTH was transiently increased. 25OHD remained low and unchanged. 1,25(OH)2D rose very slowly, but the correction of hypocalcemia began before any change in 1,25(OH)2D levels could be demonstrated. Thus, the early correction of hypocalcemia mainly depended on the restoration of an adequate parathyroid function independently of the secretion of 1,25(OH)2D.

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Calcitriol; Calcium; Ergocalciferols; Female; Humans; Hypocalcemia; Magnesium; Magnesium Chloride; Magnesium Deficiency; Male; Middle Aged; Parathyroid Hormone

Topics: Adult; Calcium; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Male; Sarcoidosis

The authors report the case of dizygotic twins suffering from transitory neonatal hypoparathyroidy and leading to the diagnosis of maternal hyperparathyroidy. The differences of clinical and biological symptomatology between these twins suggest individual variations in response to phosphocalcic disorders of the mother. A review of literature find 31 other cases. This study emphasize the aggravation by the mild hypomagnesemia frequently associated, the usual severity of initial clinical symptomatology in contrast with a good neurologic outcome, the diagnosis of maternal hyperparathyroidy.

Topics: Adult; Calcium; Diseases in Twins; Drug Combinations; Ergocalciferols; Female; Humans; Hyperparathyroidism; Hypocalcemia; Infant, Newborn; Magnesium; Male; Muscle Contraction; Pregnancy; Twins, Dizygotic

Topics: Adult; Child, Preschool; Electromyography; Ergocalciferols; Female; Humans; Hypocalcemia; Muscular Diseases; Phosphates; Pseudopseudohypoparathyroidism; Syndrome

Topics: 25-Hydroxyvitamin D 2; Child, Preschool; Ergocalciferols; Female; Humans; Hypocalcemia; Rickets

Vitamin D appears to influence parathyroid function indirectly through its effects on calcium metabolism rather than by a direct action of its metabolites on the parathyroid glands. In states of both secondary and primary hyperparathyroidism, the quantitative production of 1,25-(OH)2D may be determined by the prevailing concentration of serum 25-(OH)D but there appears to be some constraint that limits the formation of 1,25-0(OH)2D when the provision of its precursor exceeds the physiological. From the absence of this constraint in 'type 2 vitamin D dependency' it is inferred that it may operate through 'self-inhibition' of the renal production of 1,25-(OH)2D. It is shown that the level of serum 25-(OH)D may always exert some influence on the production of 1,25-(OH)2D and that this effect is facilitated by hyperparathyroidism. In developing vitamin D deficiency the reactive secondary hyperparathyroidism may thus function as an adaptive mechanism that sustains the level of serum 1,25-(OH)2D in the face of a diminishing serum 25-(OH)D. Failure of this adaptation and the development of a critical deficiency of 1,25-(OH)2D is regarded as the direct cause of defective mineralisation of bone. This concept would explain the absence of osteomalacia in some patients with very low levels of serum 25-(OH)D and the occurrence of defective osseous mineralisation in hypoparathyroidism.

Topics: 25-Hydroxyvitamin D 2; Calcitriol; Ergocalciferols; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hypocalcemia; Osteomalacia; Parathyroid Hormone; Vitamin D; Vitamin D Deficiency

A 13-year-old girl with total alopecia who in infancy had rickets unresponsive to large doses of vitamin D2 is described. She had profound hypocalcaemia which was resistant to treatment with high doses of dihydrotachysterol, 1 alpha-hydroxycholecalciferol, and 1,25-dihydroxycholecalciferol. Serum concentrations of 25-hydroxyvitamin D were normal but those of 1,25-dihydroxycholecalciferol were markedly raised (674 and 745 pg/ml). In addition, 24,25-dihydroxyvitamin D was undetectable in serum. Administration of synthetic 24,25-dihydroxycholecalciferol was followed by normocalcaemia which persisted long after treatment was stopped. Her sister, who died at the age of 10 months, also had had total alopecia, rickets, and hypocalcaemia resistant to vitamin-D2 therapy. In this familial syndrome there seems to be end-organ resistance to the action of 1,25-dihydroxycholecalciferol, possibly as a result of changes at the receptor sites.

Topics: Adolescent; Alopecia; Dihydroxycholecalciferols; Drug Resistance; Ergocalciferols; Female; Humans; Hydroxycholecalciferols; Hypocalcemia; Receptors, Drug; Rickets; Syndrome

The present study was aimed at answering the following two questions: (1) What is the effect of high dose vitamin D treatment on the serum level of 25-hydroxyvitamin D (25-OH-D) in patients with chronic renal failure (CRF)? (2) Is there any effect of urinary protein loss on the serum 25-OH-D levels during treatment with pharmacological doses of vitamin D? 42 patients with CRF were studied. They were treated conservatively by a low protein diet and received 15 mg of vitamin D2 once a week. Long-term administration of vitamin D caused a significant (5- to 7-fold) increase of plasma 25-OH-D level irrespective of the degree of proteinuria. This increase was noted only during the first 5 months of vitamin D2 treatment. Surprisingly only in some patients moderate hypercalcemia (> 2.75 mmol/l) was found. From the results obtained it is concluded that (1) patients with CRF differ from normal subjects in handling of high doses of vitamin D and (2) high dosage treatment with vitamin D may prevent hypocalcemia in patients with CRF in spite of high proteinuria.

Topics: Adult; Ergocalciferols; Female; Humans; Hydroxycholecalciferols; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Proteinuria; Time Factors

The effects of vitamin D2 (VD2) on hypocalcemia were studied in 54 hypocalcemic patients (29 males and 25 females) on chronic hemodialysis. Calcium lactate (3 g/day) or VD2 (10,000 IU/day, 50,000 IU/day and 80,000 IU/day) were administered for 4 months in order to correct the hypocalcemia. Serum calcium, phosphate and alkaline phosphatase levels were measured and the effects of VD2 on these parameters of calcium metabolism were followed. 1) Calcium lactate or 10,000 IU/day of VD2 were not effective for the correction of hypocalcemia, while 50,000-80,000 IU/day of VD2 were effective. The effects of VD2 on serum calcium concentrations were dose-dependent, and the normalization of serum calcium concentrations was achieved more rapidly with higher doses of VD2. However, in the group treated with 80,000 IU/day of VD2, many patients developed hypercalcemia, but in the group treated with 50,000 IU/day of VD2, only a few patients did it. From these results, suitable dose (initial and maintenance doses) of VD2 in dialysed patients would be 50,000 IU/day. 2) When the responder group (normal serum calcium levels after 4 months of treatment with 50,000 IU/day of VD2) and the non-responder group serum calcium levels lower than 4.2 mEq/liter on the same condition) were compared, the durations of dialysis were significantly shorter in the former than those in the latter. This fact may suggest that the effects of VD2 administration on hypocalcemia in dialysed patients are partly dependent on the residual renal function concerning the conversion of 25-OH-D3 into 1,25 (OH)2D3.

Topics: Adolescent; Adult; Aged; Ergocalciferols; Female; Humans; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Adult; Ergocalciferols; Female; Humans; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Chronic Disease; Ergocalciferols; Female; Humans; Hypocalcemia; Hypoparathyroidism; Male; Renin

Topics: Blood Glucose; Calcium; Ergocalciferols; Female; Glucose; Glucose Tolerance Test; Humans; Hypocalcemia; Hypoparathyroidism; Hypophosphatemia, Familial; Insulin; Insulin Secretion; Male; Theophylline

Topics: Cataract; Ergocalciferols; Female; Humans; Hypocalcemia; Infant; Pseudotumor Cerebri; Rickets

The aims of this study were to determine the dose of vitamin D2 that maintains the serum calcium level within the normal range in hypoparathyroid and pseudohypoparathyroid children and to establish a safe and quickly acting dose for initiating therapy in symptomatic patients. The dose requirement for maintenance therapy was studied in 11 patients and initiation therapy was studied in five newly diagnosed hypocalcemic patients. The results show that (1) the maintenance requirement of vitamin D2 is proportional to body weight and averages 2,000 IU (50 microgram)/kg/day for children of all ages and with all types of hypoparathyroid disorders and the (2) in newly diagnosed symptomatic patients, carefully controlled administration of 8,000 IU (200 microgram) vitamin D2/kg/day for the first one to two weeks corrects hypocalcemia quickly and safely.

Topics: Adolescent; Adult; Body Weight; Calcium; Child; Child, Preschool; Drug Administration Schedule; Ergocalciferols; Female; Humans; Hypocalcemia; Hypoparathyroidism; Male; Pseudohypoparathyroidism; Vitamin D

Topics: Diagnosis, Differential; Ergocalciferols; Female; Humans; Hypercalcemia; Hypocalcemia; Middle Aged; Tetany

Topics: Calcium; Child; Cholecalciferol; Chromosome Aberrations; Chromosome Disorders; Ergocalciferols; Female; Humans; Hypocalcemia; Hypophosphatemia, Familial; Infant; Intestinal Absorption; Male; Phosphates; Rickets; Vitamin D; Vitamin D Deficiency

Pseudohypoparathyroidism (PsH) is a genetic disease characterized by hypocalcemia, hyperphosphatemia, and metabolic unresponsiveness to parathyroid hormone (PTH). The administration of PTH elicits neither a significant rise in serum calcium (calcemic response) nor a decrease in the renal tubule reabsorption of phosphorus (phosphaturic response). The diminished phosphaturic response is due to an inability of PTH to generate cyclic AMP in renal tubule cells. We investigated the question of whether hypocalcemia and deficient calcemic response to PTH are due to a similar cyclic AMP defect in bone or to an acquired vitamin D deficiency. Four patients were studied. The active form of vitamin D (1,25-dihydroxycholecalciferol) was measured in 3 and was low. Treatment with vitamin D2 restored the serum calcium and the calcemic response to PTH to normal without changing the impaired renal response. Bone biopsy was performed in 2 patients and showed morphologic evidence of increased osteoclastic activity and osteomalacia. The data indicate that the hypocalcemia and bone disease in PsH are due to active vitamin D deficiency, possibly resulting from the genetic renal lesion.

Topics: Adult; Alkaline Phosphatase; Bone Diseases; Calcium; Creatine; Dihydroxycholecalciferols; Ergocalciferols; Humans; Hydroxycholecalciferols; Hypocalcemia; Middle Aged; Parathyroid Hormone; Phosphorus; Pseudohypoparathyroidism

Topics: Calcium; Child; Diet; Dihydrotachysterol; Ergocalciferols; Humans; Hypercalcemia; Hypocalcemia; Hypoparathyroidism; Magnesium; Male; Phosphorus; Vitamin D

Topics: Adolescent; Adult; Alkaline Phosphatase; Calcium; Child; Cholecalciferol; Diet; Diet, Vegetarian; Ergocalciferols; Female; Humans; Hypocalcemia; Male; Middle Aged; Osteomalacia; Phosphorus; Rickets; Seasons; United Kingdom; Vitamin D Deficiency; White People

Topics: Adolescent; Anticonvulsants; Body Height; Body Weight; Calcium; Child; Dihydrotachysterol; Epilepsy, Tonic-Clonic; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Osteomalacia; Rickets; Time Factors; Ultraviolet Therapy; Vitamin D

Topics: Adenoma; Adult; Alkaline Phosphatase; Calcium; Cardiomegaly; Cardiomyopathies; Ergocalciferols; Female; Humans; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Infant, Newborn; Infant, Newborn, Diseases; Parathyroid Hormone; Parathyroid Neoplasms; Perfusion; Phosphorus; Pregnancy; Pregnancy Complications

Topics: Calcium; Diagnosis, Differential; Ergocalciferols; Humans; Hyperparathyroidism; Hypocalcemia; Methods; Parathyroid Glands; Parathyroid Hormone; Postoperative Complications; Radioimmunoassay; Recurrence; Renal Dialysis

Topics: Adolescent; Dihydrotachysterol; Ergocalciferols; Female; Humans; Hypocalcemia; Hypoparathyroidism; Hypophosphatemia, Familial; Infant; Male; Protein-Losing Enteropathies; Pseudohypoparathyroidism

Topics: Blood Urea Nitrogen; Brain; Calcium; Electroencephalography; Ergocalciferols; Female; Humans; Hypercalcemia; Hypocalcemia; Hypoparathyroidism; Middle Aged; Phosphorus; Seizures; Thyroidectomy

Topics: Adult; Aged; Ergocalciferols; Humans; Hypercalcemia; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Ischemia; Middle Aged; Muscular Atrophy; Myelin Sheath; Neoplasms; Peripheral Nerves; Sensation; Vibration

Topics: Animals; Ergocalciferols; Hypocalcemia; Swine; Swine Diseases; Tetany

Topics: Calcium; Ergocalciferols; Female; Fetal Diseases; Fetus; Genes; Humans; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Infant, Newborn; Parathyroid Hormone; Pregnancy; Pregnancy Complications

Topics: Acupuncture Therapy; Adult; Calcium; Dihydrotachysterol; Ergocalciferols; Female; Humans; Hypocalcemia; Hypoparathyroidism; Middle Aged; Tetany

Topics: Calcium; Child; Child, Preschool; Ergocalciferols; Humans; Hypocalcemia; Infant; Phosphates; Rickets; Vitamin D Deficiency

Topics: Analysis of Variance; Animals; Bone and Bones; Bone Diseases; Cyclic AMP; Depression, Chemical; Enteral Nutrition; Ergocalciferols; Hypercalcemia; Hypocalcemia; Hypoglycemia; Hypolipidemic Agents; Injections, Intraperitoneal; Injections, Subcutaneous; Male; Nephrectomy; Pancreatectomy; Parathyroid Glands; Phosphates; Rats; Thiophenes; Thyroidectomy

Topics: Abscess; Adrenal Insufficiency; Adult; Calcium; Chloramphenicol; Citrates; Citric Acid Cycle; Empyema; Empyema, Tuberculous; Ergocalciferols; Female; Furunculosis; Humans; Hypercalcemia; Hypocalcemia; Intestinal Absorption; Isoniazid; Klebsiella Infections; Lung Abscess; Lupus Vulgaris; Lymphadenitis; Male; Middle Aged; Paronychia; Penicillins; Pleurisy; Prednisone; Streptomycin; Suppuration; Tuberculosis, Pulmonary

Topics: Adrenal Cortex Hormones; Adult; Calcium; Diet Therapy; Ergocalciferols; Female; Goiter; Humans; Hypercalcemia; Hypocalcemia; Inositol; Kidney Failure, Chronic; Male; Middle Aged; Nephrocalcinosis; Thyroidectomy; Time Factors; Vitamin D

Topics: Arrhythmias, Cardiac; Calcium; Child; Electrocardiography; Ergocalciferols; Humans; Hypocalcemia; Male; Vitamin D Deficiency

Topics: Adult; Calcium; Ergocalciferols; Female; Humans; Hypercalcemia; Hypocalcemia; Hypoparathyroidism; Lactates; Male; Middle Aged

Topics: Adenocarcinoma; Adult; Calcium; Electrocardiography; Electroencephalography; Epilepsy; Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Lung Neoplasms; Male

Topics: Adenoma; Adult; Bone Resorption; Calcium; Ergocalciferols; Female; Hand; Humans; Hyperparathyroidism; Hyperthyroidism; Hypocalcemia; Osteoclasts; Parathyroid Neoplasms; Pelvis; Postoperative Complications; Radiography; Skull; Tetany

Topics: Adolescent; Adult; Anemia, Macrocytic; Bicarbonates; Calcium; Ergocalciferols; Female; Folic Acid Deficiency; Humans; Hypocalcemia; Middle Aged; Neurologic Manifestations; Osteomalacia; Pain; Seizures; Tetany; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Topics: Calcium; Cardiomegaly; Child; Ergocalciferols; Humans; Hypocalcemia; Intellectual Disability; Male

Topics: Drug Therapy; Ergocalciferols; Gastrectomy; Humans; Hypocalcemia; Hypoparathyroidism; Postgastrectomy Syndromes

Topics: Diagnosis; Electroencephalography; Epilepsy; Ergocalciferols; Humans; Hypocalcemia

Topics: Dihydrotachysterol; Drug Therapy; Ergocalciferols; Humans; Hyperparathyroidism; Hypocalcemia; Hypoparathyroidism; Tetany

Topics: Calcium; Calcium, Dietary; Drug Therapy; Ergocalciferols; Humans; Hypocalcemia; Postoperative Complications; Psoriasis; Thyroidectomy

Topics: Calcium; Calcium, Dietary; Citrates; Diet; Ergocalciferols; Humans; Hypocalcemia; Intestine, Small; Intestines; Magnesium; Urinary Tract

Topics: Ergocalciferols; Humans; Hypocalcemia; Hypoparathyroidism; Iatrogenic Disease; Postoperative Complications; Psoriasis; Tetany; Thyroidectomy

Topics: Androgens; Blood Chemical Analysis; Bone Diseases; Calcium Isotopes; Calcium Metabolism Disorders; Citrates; Ergocalciferols; Estrogens; Hypocalcemia; Osteomalacia; Osteopetrosis; Osteoporosis; Parathyroid Glands; Pharmacology; Phosphates; Physiology; Radiometry; Strontium Isotopes; Urine

Topics: Blood; Embryo Implantation; Ergocalciferols; Female; Humans; Hypocalcemia; Pregnancy; Premature Birth