Hypocalcemia Due to Hypomagnesemia and Reversible Parathyroid Hormone Unresponsiveness

Estep, Herschel L.; Shaw, Walter A.; Watlington, Charles O.; Hobe, Richard; Holland, William L.; Tucker, St. George

doi:10.1210/jcem-29-6-842

Cited by 241 publications

(80 citation statements)

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“…Mg deficiency is often caused by malnutrition, such as chronic alcoholism [1,8,31,32] and gastrointentinal disorders [1,33,34], which might also cause hypophosphatemia in our patient. Indeed, the complication of low T3 syndrome and vitamin D deficiency or insufficiency suggests the existence of malnutrition in this case.…”

Section: Discussionmentioning

confidence: 76%

“…SERUM calcium levels are normally regulated within a relatively narrow range by the parathyroid gland through a negative feedback mechanism: Increased secretion of parathyroid hormone (PTH) by a fall in blood calcium levels enhances the mobilization of calcium, mainly by bone resorption, and then calcium levels are rapidly restored. Chronic magnesium (Mg) deficiency would result in hypocalcemia [1, 2], because of the impairment of PTH secretion [3][4][5][6][7] and/ or resistance of target organ to PTH action [4,6,8].Previous studies have demonstrated that serum PTH concentration was suppressed in patients with hypomagnesemia [4,5], and Mg substitution therapy enhanced PTH secretion and reversed PTH target-organ resistance, and thus serum calcium concentration returned to normal within several days [4,7]. In addition, Mg deficiency could inhibit the synthesis of 1,25-dihydroxy vitamin D (1,25(OH) 2 D) [9][10][11] as well as its action on bone [11].…”

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confidence: 99%

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confidence: 99%

“…Chronic magnesium (Mg) deficiency would result in hypocalcemia [1,2], because of the impairment of PTH secretion [3][4][5][6][7] and/ or resistance of target organ to PTH action [4,6,8]. Previous studies have demonstrated that serum PTH concentration was suppressed in patients with hypomagnesemia [4,5], and Mg substitution therapy enhanced PTH secretion and reversed PTH target-organ resistance, and thus serum calcium concentration returned to normal within several days [4,7].…”

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confidence: 99%

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A Case of Magnesium Deficiency Associated with Insufficient Parathyroid Hormone Action and Severe Osteoporosis

et al. 2007

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Abstract. The relationship between osteoporosis and magnesium (Mg) deficiency is still controversial. Here we report a case of an 82-year-old woman with a giant adenomatous goiter and severe osteoporosis with multiple vertebral fractures, whose clinical course indicated that her osteoporosis was probably due to Mg deficiency. She visited our hospital for treatments of tetany. Laboratory data showed the existence of hypomagnesemia, hypocalcemia, hypokalemia, vitamin D deficiency, and slightly elevated intact PTH. Intravenous administration of Mg not only improved these electrolyte abnormalities but also increased serum levels of intact PTH, bone formation markers, 1,25-dihydroxyvitamin D, as well as bone resorption markers in the urine, and lowered urinary phosphate reabsorption. Hypomagnesemia on admission seemed to arise from long-lasting poor food intake and malnutrition, because it improved after the disappearance of dysphagia with a goiter resection. After the operation, BMD values at the lumbar spine and femoral neck obviously increased during 6 months of Mg supplementation without any specific therapies for osteoporosis. Mg deficiency in this case seemed to cause impaired secretion of PTH from the parathyroid and the refractoriness of bone and kidney to the hormone, which led to the suppression of both bone remodeling and renal vitamin D production. These processes were probably linked to her severe osteoporosis, which was reversed by Mg supplementation. SERUM calcium levels are normally regulated within a relatively narrow range by the parathyroid gland through a negative feedback mechanism: Increased secretion of parathyroid hormone (PTH) by a fall in blood calcium levels enhances the mobilization of calcium, mainly by bone resorption, and then calcium levels are rapidly restored. Chronic magnesium (Mg) deficiency would result in hypocalcemia [1, 2], because of the impairment of PTH secretion [3][4][5][6][7] and/ or resistance of target organ to PTH action [4,6,8].Previous studies have demonstrated that serum PTH concentration was suppressed in patients with hypomagnesemia [4,5], and Mg substitution therapy enhanced PTH secretion and reversed PTH target-organ resistance, and thus serum calcium concentration returned to normal within several days [4,7]. In addition, Mg deficiency could inhibit the synthesis of 1,25-dihydroxy vitamin D (1,25(OH) 2 D) [9][10][11] as well as its action on bone [11]. Accumulating data have shown that a long-term Mg deficiency and resulting hypomagnesemia could cause osteoporosis and bone fractures through these dysfunctions of PTH and vitamin D action [12,[13][14][15][16][17][18][19]. However, other studies have shown no relationship between Mg deficiency and osteoporosis [20][21][22], and it still seems to be controversial whether or not Mg deficiency could cause osteoporosis. Here we report a patient with a giant adenomatous goiter and severe osteoporosis exhibiting hypomagnesemic hypocalcemia, whose osteoporosis was reversed by Mg supplementation with chronological improv...

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Section: Discussionmentioning

confidence: 76%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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A Case of Magnesium Deficiency Associated with Insufficient Parathyroid Hormone Action and Severe Osteoporosis

et al. 2007

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“…The effects of alcohol ingestion on electrolyte balance are only partly understood but several mechanisms of hypocalcaemia have been implied (Table 1). [1][2][3] Coeliac disease is a common condition (prevalence 1:300) with sensitivity to dietary gluten resulting in immune-mediated destruction of small bowel villi, villous atrophy, reduced surface area and malabsorption of calcium and vitamin D. 4 Although detection of tissue transglutimase IgA is a highly sensitive and specific test, the gold standard for diagnosis currently remains duodenal biopsy. Treatment consists of complete avoidance of gluten with restoration of normal mucosa with reversal of malabsorption.…”

Section: Discussionmentioning

confidence: 99%

An alcoholic presenting with fits

Jordan¹,

Ralph²,

Heydtmann³

2009

Clinical Medicine

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A 49-year-old known alcoholic was admitted to hospital after being found collapsed with a witnessed minor haematemesis and melaena. The patient had multiple admissions to hospital with seizures that had been attributed to either alcohol intoxication or withdrawal. An emergency endoscopy revealed oesophageal ulcers. He suffered a seizure on admission and while recovering carpopedal spasm was noted and Chvostek's sign was positive. Initial blood investigations included potassium 2.9 mmol/l and calcium of 1.2 mmol/l treated with intravenous (iv) calcium gluconate. Blood tests revealed consistently low calcium levels (Fig 1) and a normal parathyroid hormone, compatible with primary hypoparathyroidism. He was noted to be anaemic and gave a history of diarrhoea. His serological tests for coeliac disease were positive and duodenal biopsy and histology confirmed inflammation and villous atrophy. He was advised to follow a gluten-free diet in addition to standard management for alcohol dependency. The patient re-presented to accident and emergency a few months later with a further seizure and died shortly after admission.

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Excretion of phosphate and calcium. Physiology of their renal handling and relation to clinical medicine

Massry¹

1973

Archives of Internal Medicine

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Hypocalcemia Due to Hypomagnesemia and Reversible Parathyroid Hormone Unresponsiveness

Cited by 241 publications

References 1 publication

A Case of Magnesium Deficiency Associated with Insufficient Parathyroid Hormone Action and Severe Osteoporosis

A Case of Magnesium Deficiency Associated with Insufficient Parathyroid Hormone Action and Severe Osteoporosis

An alcoholic presenting with fits

Excretion of phosphate and calcium. Physiology of their renal handling and relation to clinical medicine

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