Laura L Sweeney1, Alan O Malabanan, Harold Rosen. 1. Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: To describe the changes in calcium and calcitriol requirements during pregnancy and lactation in a patient with hypoparathyroidism due to autosomal dominant hypocalcemia. METHODS: We summarize the clinical presentation and treatment of the patient and review the pertinent literature. RESULTS: Calcitriol requirements disappeared during pregnancy in a 34-year-old woman with autosomal dominant hypoparathyroidism secondary to an activating mutation in the calcium-sensing receptor gene. Within hours after delivery, her serum calcium concentration dropped to 4.7 mg/dL (albumin, 3.2 g/dL), and she required intravenous calcium and reinstitution of calcitriol. When lactation began a few days later, her calcitriol requirement again disappeared. As has occasionally been described in the literature, this patient with hypoparathyroidism required no calcitriol during late pregnancy and lactation to maintain a normal serum calcium level. CONCLUSIONS: To our knowledge, this is the first reported case documenting a period of time between pregnancy and lactation when calcitriol requirements reappeared, likely due to a parathyroid hormone-related protein "window" between delivery, when placental production of parathyroid hormone-related protein stops, and lactation, when mammary gland production begins.
OBJECTIVE: To describe the changes in calcium and calcitriol requirements during pregnancy and lactation in a patient with hypoparathyroidism due to autosomal dominant hypocalcemia. METHODS: We summarize the clinical presentation and treatment of the patient and review the pertinent literature. RESULTS:Calcitriol requirements disappeared during pregnancy in a 34-year-old woman with autosomal dominant hypoparathyroidism secondary to an activating mutation in the calcium-sensing receptor gene. Within hours after delivery, her serum calcium concentration dropped to 4.7 mg/dL (albumin, 3.2 g/dL), and she required intravenous calcium and reinstitution of calcitriol. When lactation began a few days later, her calcitriol requirement again disappeared. As has occasionally been described in the literature, this patient with hypoparathyroidism required no calcitriol during late pregnancy and lactation to maintain a normal serum calcium level. CONCLUSIONS: To our knowledge, this is the first reported case documenting a period of time between pregnancy and lactation when calcitriol requirements reappeared, likely due to a parathyroid hormone-related protein "window" between delivery, when placental production of parathyroid hormone-related protein stops, and lactation, when mammary gland production begins.
Authors: Aliya A Khan; Christian A Koch; Stan Van Uum; Jean Patrice Baillargeon; Jens Bollerslev; Maria Luisa Brandi; Claudio Marcocci; Lars Rejnmark; Rene Rizzoli; M Zakarea Shrayyef; Rajesh Thakker; Bulent O Yildiz; Bart Clarke Journal: Eur J Endocrinol Date: 2019-03 Impact factor: 6.664
Authors: Jens Bollerslev; Lars Rejnmark; Alexandra Zahn; Ansgar Heck; N M Appelman-Dijkstra; Luis Cardoso; Fadil M Hannan; Filomena Cetani; Tanja Sikjær; Anna Maria Formenti; Sigridur Björnsdottir; Camilla Schalin-Jantti; Zhanna Belaya; Fraser Wilson Gibb; Bruno Lapauw; Karin Amrein; Corinna Wicke; Corinna Grasemann; Michael Krebs; Eeva M Ryhänen; Ozer Makay; Salvatore Minisola; Sebastien Gaujoux; Jean-Philippe Bertocchio; Zaki K Hassan-Smith; Agnès Linglart; Elizabeth M Winter; Martina Kollmann; Hans-Georg Zmierczak; Elena Tsourdi; Stefan Pilz; Heide Siggelkow; Neil J Gittoes; Claudio Marcocci; Peter Kamenicky Journal: Eur J Endocrinol Date: 2022-01-13 Impact factor: 6.664