Post-partum Hypercalcaemia in Treated Hypoparathyroidism

Wright, Alex; Joplin, G. F.; Dixon, H. G.

doi:10.1136/bmj.1.5635.23

Cited by 34 publications

(19 citation statements)

References 5 publications

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“…These events mandate careful monitoring of serum calcium levels in women with HypoPT who are nursing because hypercalcaemia is commonly encountered if vitamin D analogue therapy is not quickly adjusted. The onset of hypercalcaemia during breastfeeding can be immediate (97,101,102,103,104,105) and has even been reported when treating women with HypoPT with longer-acting ergocalciferol, who did not breastfeed (106). Gradually after weaning, the above changes in maternal hormones regress, and a new steady-state is achieved.…”

Section: Special Circumstancesmentioning

confidence: 99%

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Bollerslev¹,

Rejnmark²,

Marcocci³

et al. 2015

European Journal of Endocrinology

385

411

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Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease. We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients. This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base. The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence. This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors. (2015) 173, G1-G20 European Journal of Endocrinology Summary of recommendationsThe recommendations are worded as recommend (strong recommendation) and suggest (weak recommendation). We formally graded only the evidence underlying recommendations for therapeutic choices and target calcium levels. The quality of evidence behind the recommendations is classified as very low (4BBB), low (44BB), moderate (444B) and strong (4444). See further section 'Summary of methods used for guideline development'. European Journal of EndocrinologyClinical Practice Guideline J Bollerslev, L Rejnmark and others ESE guideline on treatment of chronic HypoPT

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Section: Special Circumstancesmentioning

confidence: 99%

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Bollerslev¹,

Rejnmark²,

Marcocci³

et al. 2015

European Journal of Endocrinology

385

411

View full text Add to dashboard Cite

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“…Some reports have found no change in the serum calcium during pregnancy while on a stable dose of calcium with vitamin D or calcitriol (213,264,995), with two of these reporting a small increase in serum calcium in the last few days before delivery (264,995). Since the serum calcium was not adjusted for the serum albumin in these cases (213,264,995), the lack of fall in unadjusted serum calcium during pregnancy may indicate that the ionized calcium had increased.…”

Section: Human Datamentioning

confidence: 99%

“…Since the serum calcium was not adjusted for the serum albumin in these cases (213,264,995), the lack of fall in unadjusted serum calcium during pregnancy may indicate that the ionized calcium had increased. Two reports found that the ionized calcium did not change throughout pregnancy (30,302), but in one of these cases it abruptly fell and became symptomatic during labor (302).…”

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

384

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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“…Hypercalcaemia can also occur immediately after delivery in women with hypoparathyroidism treated with vitamin D supplements. 5 6 All these observations support a crucial role for oestrogen in calcium regulation in these women.…”

Section: Commentmentioning

confidence: 58%

Lesson of the week Oestrogen and calcium homeostasis in women with hypoparathyroidism

McIlroy¹,

Dryburgh²,

Hinnie³

et al. 1999

BMJ

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Post-partum Hypercalcaemia in Treated Hypoparathyroidism

Cited by 34 publications

References 5 publications

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Lesson of the week Oestrogen and calcium homeostasis in women with hypoparathyroidism

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