Palal Betsy, Sinsakul Marvin, Reutrakul Sirimon
Section of Endcrinology, Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
Case Rep Endocrinol. 2011;2011:370583. doi: 10.1155/2011/370583. Epub 2011 Oct 29.
Background. Roux-en-Y gastric bypass (RYGB) can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration.
背景。Roux-en-Y胃旁路术（RYGB）可导致钙和维生素D缺乏。甲状旁腺手术存在即刻和长期低钙血症的风险。方法与结果。我们描述了一名54岁女性，有终末期肾病和胃旁路手术史，发生了钙化防御，需要进行3.5个腺体的甲状旁腺切除术。七周后，她出现乏力、口周麻木、腿部痉挛、Chvostek征阳性、低血压、QT间期延长，血清钙为5.4mg/dL。给予了口服和静脉补钙、骨化三醇以及高钙浴血液透析。她需要18天的静脉补钙以及骨化三醇6μg/天、碳酸钙8克/天、枸橼酸钙1.2克/天和麦角钙化醇50,000IU/周的门诊维持治疗方案。结论。患者危及生命的长期低钙血症以及对钙和骨化三醇的大量需求是由于吸收不良、甲状旁腺功能减退和肾衰竭共同作用所致。对于接受颈部探查的减肥手术患者应给予特殊考虑。
