Chinoy A, Skae M, Babiker A, Kendall D, Mughal M Z, Padidela R
Royal Manchester Children's HospitalManchester, UK.
King Abdullah Specialized Children's HospitalRiyadh, Saudi Arabia.
Endocr Connect. 2017 Nov;6(8):589-594. doi: 10.1530/EC-17-0234.
Hypoparathyroidism is characterised by hypocalcaemia, and standard management is with an active vitamin D analogue and adequate oral calcium intake (dietary and/or supplements). Little is described in the literature about the impact of intercurrent illnesses on calcium homeostasis in children with hypoparathyroidism.
We describe three children with hypoparathyroidism in whom intercurrent illnesses led to hypocalcaemia and escalation of treatment with alfacalcidol (1-hydroxycholecalciferol) and calcium supplements.
Three infants managed with standard treatment for hypoparathyroidism (two with homozygous mutations in gene and one with Sanjad-Sakati syndrome) developed symptomatic hypocalcaemia (two infants developed seizures) following respiratory or gastrointestinal illnesses. Substantial increases in alfacalcidol doses (up to three times their pre-illness doses) and calcium supplementation were required to achieve acceptable serum calcium concentrations. However, following resolution of illness, these children developed an increase in serum calcium and hypercalciuria, necessitating rapid reduction to pre-illness dosages of alfacalcidol and oral calcium supplementation.
Intercurrent illness may precipitate symptomatic hypocalcaemia in children with hypoparathyroidism, necessitating increase in dosages of alfacalcidol and calcium supplements. Close monitoring is required on resolution of the intercurrent illness, with timely reduction of dosages of active analogues of vitamin D and calcium supplements to prevent hypercalcaemia, hypercalciuria and nephrocalcinosis.
甲状旁腺功能减退症的特征是低钙血症，标准治疗方法是使用活性维生素D类似物并摄入足够的口服钙（饮食和/或补充剂）。关于并发疾病对甲状旁腺功能减退症儿童钙稳态的影响，文献中描述较少。
我们描述了三名甲状旁腺功能减退症儿童，他们的并发疾病导致了低钙血症，并使阿法骨化醇（1-羟胆钙化醇）和钙补充剂的治疗升级。
三名接受甲状旁腺功能减退症标准治疗的婴儿（两名患有基因纯合突变，一名患有桑贾德-萨卡蒂综合征）在呼吸道或胃肠道疾病后出现了症状性低钙血症（两名婴儿出现惊厥）。需要大幅增加阿法骨化醇剂量（高达患病前剂量的三倍）和钙补充剂，以达到可接受的血清钙浓度。然而，疾病缓解后，这些儿童的血清钙升高，出现高钙尿症，因此需要迅速将阿法骨化醇和口服钙补充剂的剂量降至患病前水平。
并发疾病可能会促使甲状旁腺功能减退症儿童出现症状性低钙血症，需要增加阿法骨化醇和钙补充剂的剂量。并发疾病缓解后需要密切监测，及时减少维生素D活性类似物和钙补充剂的剂量，以预防高钙血症、高钙尿症和肾钙质沉着症。
