Elkattawy Sherif, Alyacoub Ramez, Ayad Sarah, Pandya Manthan, Eckman Ari
Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA.
Internal Medicine-Endocrinology, Robert Wood Johnson University Hospital, New Brunswick, USA.
Cureus. 2020 Aug 28;12(8):e10097. doi: 10.7759/cureus.10097.
Hypoparathyroidism is usually caused by postsurgical or autoimmune damage to the parathyroid gland. We present the case of a 46-year-old Hispanic male with no significant past medical history who was admitted to the hospital with hypoxic respiratory failure due to coronavirus disease 2019 (COVID-19) infection and had a prolonged hospital course. He was incidentally found to have hyperphosphatemia and low parathyroid hormone (PTH) levels. During the second month of hospitalization, his phosphorus levels rose to 6.9 mg/dL (normal range: 2.4-4.7 mg/dl). His PTH levels were found to be at 8 pg/mL. Vitamin D levels obtained were also low (7 ng/dL), phosphorus was at 5.8 mg/dL with albumin of 2.9 g/dL, and calcium level was normal at 9.2 mg/dl. Parathyroid hormone-related peptide (PTHrP) level was low at 10. Malignancy and genetic causes were ruled out. The patient was started on 50,000 units of ergocalciferol once a week. He was also started on calcium acetate 1,334 mg three times a day for hyperphosphatemia. Phosphorus levels remained elevated, and sevelamer was added on discharge after he was weaned off oxygen and cleared by physical therapy. No explanation for persistent hyperphosphatemia and hypoparathyroidism was found. To date, there have been some reports linking severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to widespread tissue injury; however, there have been no reports so far on the effect of the parathyroid gland. Further studies are necessary to elaborate and to confirm the causative relationship between SARS-CoV-2 and hyperphosphatemia.
甲状旁腺功能减退通常由甲状旁腺的术后损伤或自身免疫损伤引起。我们报告一例46岁的西班牙裔男性病例，该患者既往无重大病史，因2019冠状病毒病（COVID-19）感染导致低氧性呼吸衰竭入院，住院时间较长。他偶然发现有高磷血症和低甲状旁腺激素（PTH）水平。在住院的第二个月，他的磷水平升至6.9mg/dL（正常范围：2.4 - 4.7mg/dL）。发现他的PTH水平为8pg/mL。检测的维生素D水平也较低（7ng/dL），磷为5.8mg/dL，白蛋白为2.9g/dL，钙水平正常，为9.2mg/dL。甲状旁腺激素相关肽（PTHrP）水平较低，为10。排除了恶性肿瘤和遗传原因。患者开始每周一次服用50000单位的骨化醇。他还开始每天三次服用1334mg醋酸钙以治疗高磷血症。磷水平仍然升高，在他脱机并通过物理治疗康复后出院时加用了司维拉姆。未发现持续性高磷血症和甲状旁腺功能减退的原因。迄今为止，已有一些报告将严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与广泛的组织损伤联系起来；然而，到目前为止，尚无关于甲状旁腺影响的报告。需要进一步研究以阐明并确认SARS-CoV-2与高磷血症之间的因果关系。
