Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Riad El Solh, Lebanon.
Eur J Endocrinol. 2012 Jun;166(6):1113-20. doi: 10.1530/EJE-11-1094. Epub 2012 Mar 19.
Hypocalcemia secondary to hypoparathyroidism is a rare cause of congestive heart failure. However, its early recognition and treatment lead to significant improvement in cardiac function. We report a middle-aged woman presenting with symptoms of heart failure with a serum calcium level of 3.7 mg/dl and a serum inorganic phosphate level of 17.6 mg/dl 22 years after subtotal thyroidectomy. Besides calcium and calcitriol supplementation, she was the first patient with severe hypocalcemic cardiomyopathy to be given off-label recombinant human parathyroid hormone (PTH) because of an elevated serum calcium-phosphate product. We discuss the management and outcome of the patient and then present a brief review of similar previously reported cases. We also describe the pivotal role of calcium ion and the potential role of PTH in maintaining myocardial contractility, effective natriuresis, and possible pathogenic mechanisms contributing to heart failure secondary to hypocalcemia and hypoparathyroidism.
甲状旁腺功能减退导致的低钙血症是充血性心力衰竭的罕见病因。然而，早期识别和治疗可显著改善心脏功能。我们报告了一名中年女性，在甲状腺次全切除术后 22 年出现心力衰竭症状，血清钙水平为 3.7mg/dl，血清无机磷水平为 17.6mg/dl。除了补钙和补充骨化三醇外，由于血清钙磷乘积升高，她是首位接受未经批准的重组人甲状旁腺激素（PTH）治疗的严重低钙性心肌病患者。我们讨论了患者的治疗和转归，并简要回顾了类似的既往报道病例。我们还描述了钙离子的关键作用以及 PTH 维持心肌收缩力、有效排钠和可能导致低钙血症和甲状旁腺功能减退引起心力衰竭的潜在致病机制的作用。
