Case Study: Management of Hyperparathyroidism with Calcitriol

Case Study: Management of Hyperparathyroidism with Calcitriol

Patient Profile:

• Name: Sarah Johnson
• Age: 58
• Gender: Female
• Medical History: Hypertension, Osteoporosis

Presenting Complaint: Sarah Johnson presents to the endocrinology clinic with complaints of persistent fatigue, muscle weakness, and bone pain. She reports a history of osteoporosis diagnosed five years ago, for which she has been receiving bisphosphonate therapy. Despite adherence to treatment, she has experienced recurrent fractures and worsening bone density on recent dual-energy X-ray absorptiometry (DXA) scan. Laboratory investigations reveal elevated serum calcium levels (11.2 mg/dL) and increased parathyroid hormone (PTH) concentrations (95 pg/mL), consistent with hyperparathyroidism.

Assessment: Upon further evaluation, Sarah’s medical team performs imaging studies, including neck ultrasound and sestamibi scan, confirming the presence of a parathyroid adenoma. Given Sarah’s history of osteoporosis and concerns regarding surgical risks, her endocrinologist proposes initiating pharmacological therapy with calcitriol to manage her hyperparathyroidism.

Treatment Plan: Sarah’s treatment plan involves the following steps:

1. Calcitriol Therapy Initiation:
   • Sarah’s endocrinologist prescribes calcitriol (0.25 mcg orally once daily) to suppress PTH secretion and normalize serum calcium levels.
   • The dosage is carefully selected to avoid overshooting the desired therapeutic effect and minimize the risk of hypercalcemia.
2. Monitoring and Follow-up:
   • Regular follow-up appointments are scheduled to monitor Sarah’s response to calcitriol therapy.
   • Serum calcium and phosphorus levels are closely monitored to assess treatment efficacy and safety.
   • Bone mineral density measurements are repeated periodically to evaluate the impact of therapy on Sarah’s osteoporosis.

Outcome: Over the course of six months, Sarah demonstrates significant improvements in her clinical symptoms and laboratory parameters. Her serum calcium levels normalize (9.4 mg/dL), and PTH concentrations decrease within the reference range (35 pg/mL). Follow-up DXA scans reveal stabilization of bone mineral density and a reduction in fracture risk. Sarah reports feeling more energetic and experiences a reduction in muscle weakness and bone pain.

Discussion: Sarah’s case highlights the role of calcitriol as a pharmacological agent in the management of hyperparathyroidism, particularly in patients who are not candidates for surgery or prefer non-invasive treatment options. By suppressing PTH secretion, enhancing intestinal calcium absorption, and promoting bone mineralization, calcitriol addresses the underlying pathophysiology of hyperparathyroidism and mitigates associated complications such as osteoporosis.

Conclusion: Calcitriol therapy represents a valuable therapeutic approach in the management of hyperparathyroidism, offering patients like Sarah an effective alternative to surgical intervention. Through careful monitoring and individualized treatment plans, healthcare providers can optimize the use of calcitriol to achieve favorable outcomes in patients with hyperparathyroidism and associated comorbidities such as osteoporosis.

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