Felsenfeld A J, Drezner M K, Llach F
Arch Intern Med. 1986 Oct;146(10):1941-5.
A patient on maintenance hemodialysis had widely disseminated tuberculosis, hypercalcemia, and elevated levels of calcitriol (1,25-dihydroxycholecalciferol). Hypercalcemia was not observed until the eighth month of hemodialysis, when persistent fevers began. At the end of a calcium-free dialysis, the plasma calcium concentration decreased to 6.6 mg/dL (1.65 mmol/L). The baseline calcitriol level was 56 pg/mL (normal, 19 to 50 pg/mL) and increased to 147 pg/mL at the end of hemodialysis. Parathyroid hormone levels by three separate assays did not appreciably increase during the hypocalcemia induced by the calcium-free hemodialysis. The serum phosphate concentration decreased from 7.3 to 4.5 mg/dL (2.36 to 1.45 mmol/L). Extrarenal production of calcitriol may occur in disseminated tuberculosis and may be stimulated by hypocalcemia and reduced serum phosphate. The expected parathyroid hormone response to hypocalcemia may have been inhibited by persistently elevated calcitriol levels or preexisting hypercalcemia.
一名维持性血液透析患者患有播散性结核病、高钙血症以及骨化三醇（1,25-二羟胆钙化醇）水平升高。直到血液透析的第八个月出现持续发热时才观察到高钙血症。在无钙透析结束时，血浆钙浓度降至6.6mg/dL（1.65mmol/L）。骨化三醇基线水平为56pg/mL（正常范围19至50pg/mL），血液透析结束时升至147pg/mL。在无钙血液透析诱导的低钙血症期间，通过三次独立检测的甲状旁腺激素水平没有明显升高。血清磷酸盐浓度从7.3mg/dL降至4.5mg/dL（2.36mmol/L降至1.45mmol/L）。骨化三醇的肾外产生可能发生在播散性结核病中，并且可能受到低钙血症和血清磷酸盐降低的刺激。甲状旁腺激素对低钙血症的预期反应可能已被持续升高的骨化三醇水平或先前存在的高钙血症所抑制。
