Vitamin D insufficiency underlies unexpected hypocalcemia following high dose glucocorticoid therapy

Abstract Vitamin D insufficiency is a reemerging and common health problem for skeletal system. Pharmacological application of glucocorticoid inhibits intestinal calcium absorption and stimulates tubular calcium excretion, thus induces severely negative calcium balance. We report a patient presentin...

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Bibliographic Details
Published in:Bone (New York, N.Y.) N.Y.), 2008-01, Vol.42 (1), p.226-228
Main Authors: Kinoshita, Yuka, Masuoka, Kazuhiro, Miyakoshi, Shigesaburo, Taniguchi, Shuichi, Takeuchi, Yasuhiro
Format: Article
Language:English
Subjects:
25-Hydroxyvitamin D
Biological and medical sciences
Biomarkers - blood
Bisphosphonate
Bone formation
Bone resorption
Bone Resorption - blood
Bones, joints and connective tissue. Antiinflammatory agents
Calcium - blood
Cord Blood Stem Cell Transplantation
Female
Fundamental and applied biological sciences. Psychology
Glucocorticoids - therapeutic use
Humans
Hypocalcemia - chemically induced
Leukemia, T-Cell - surgery
Lymphoma - surgery
Medical sciences
Middle Aged
Orthopedics
Osteogenesis
Pharmacology. Drug treatments
Phosphates - blood
Skeleton and joints
Vertebrates: osteoarticular system, musculoskeletal system
Vitamin D Deficiency - drug therapy
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Summary:Abstract Vitamin D insufficiency is a reemerging and common health problem for skeletal system. Pharmacological application of glucocorticoid inhibits intestinal calcium absorption and stimulates tubular calcium excretion, thus induces severely negative calcium balance. We report a patient presenting symptomatic hypocalcemia following high dose glucocorticoid administration. After a pulse-therapy with methylprednisolone, hypocalcemia with muscle cramp developed in association with hypercalciuria and secondary hyperparathyroidism in the absence of hypomagnesemia. Circulating level of 1,25-dihydroxyvitamin D was in a reference range, while that of 25-hydroxyvitamin D was insufficient. Treatment with alfacalcidol of 1 μg/day promptly improved serum calcium level within a couple of weeks. Vitamin D insufficiency could be a serious problem in patients with high dose glucocorticoid therapy.
ISSN:8756-3282
1873-2763
DOI:10.1016/j.bone.2007.09.042