Case Study:

Patient Profile:

• Patient’s Name: Emily
• Age: 55 years
• Gender: Female
• Chief Complaint: Fatigue, frequent fractures, and elevated blood calcium levels

Medical History:

Emily is a 55-year-old woman with a history of chronic kidney disease (CKD) and a previous diagnosis of primary hyperparathyroidism. She has been experiencing persistent fatigue, frequent fractures, and recently noticed her blood calcium levels rising on routine blood tests.

Clinical Assessment:

Upon evaluation and laboratory tests, Emily’s healthcare provider identifies the following:

• Serum Calcium Levels: Elevated at 11.8 mg/dL (normal range: 8.5-10.4 mg/dL)
• Parathyroid Hormone (PTH) Levels: Significantly elevated
• Bone Density: Reduced bone density is observed on dual-energy X-ray absorptiometry (DXA) scan, consistent with osteoporosis.

Treatment Plan:

Emily’s healthcare provider develops a comprehensive treatment plan for her hypercalcemia and underlying parathyroid disorder:

• Calcitonin Administration: Given the severity of Emily’s symptoms, including fatigue and frequent fractures, and her history of CKD, calcitonin is administered intravenously. The immediate goal is to provide rapid relief by inhibiting bone resorption and promoting renal excretion of calcium.
• Bisphosphonate Therapy: In addition to calcitonin, Emily is prescribed bisphosphonate medication, such as alendronate, to further inhibit bone resorption and improve bone density. This treatment aims to provide long-term management of osteoporosis.
• Management of CKD: Emily’s chronic kidney disease is carefully managed with medications and dietary adjustments to optimize kidney function. Maintaining kidney health is essential for calcium balance.
• Evaluation of Parathyroid Glands: Emily undergoes imaging studies, such as neck ultrasound or sestamibi scan, to identify the underlying cause of primary hyperparathyroidism. These tests help locate any abnormal parathyroid tissue.

Progress and Results:

Over several weeks, Emily’s treatment progresses as follows:

• Symptom Relief: Emily experiences significant relief from her symptoms, with improved energy levels and reduced fracture risk.
• Blood Calcium Levels: Serial blood tests show a gradual reduction in serum calcium levels, eventually returning to the normal range.
• Identification of Parathyroid Adenoma: Imaging studies identify a parathyroid adenoma as the underlying cause of Emily’s primary hyperparathyroidism. Surgical consultation is arranged for adenoma removal.
• Bone Health Improvement: DXA scans performed after several months of bisphosphonate therapy show improvement in bone density, indicating successful management of osteoporosis.

Conclusion:

Emily’s case demonstrates the critical role of calcitonin in the management of severe hypercalcemia and primary hyperparathyroidism, particularly in individuals with complicating factors such as chronic kidney disease. Calcitonin, in conjunction with bisphosphonates and diligent management of CKD, provided rapid relief from debilitating symptoms, reduced blood calcium levels, and improved bone health.

For patients like Emily, a multidisciplinary approach is essential, addressing both calcium balance and underlying parathyroid disorders. Identifying and treating the source of hyperparathyroidism, in this case, the parathyroid adenoma, is crucial for long-term management and prevention of recurrence.

Calcitonin’s role as a therapeutic agent, when used in conjunction with other treatments, underscores its significance in managing complex hormonal conditions, ultimately improving the quality of life for individuals facing these challenges.

Calcitonin Therapy in the Management of Paget’s Disease of Bone