Case Study: Management of Hypoparathyroidism with Calcitriol Therapy
Patient Information: Name: Sarah M. Age: 45 Gender: Female Chief Complaint: Muscle cramps, tingling sensations, and fatigue
History: Sarah M., a 45-year-old female, presented to the endocrinology clinic with complaints of recurrent muscle cramps, tingling sensations in her extremities, and persistent fatigue over the past few months. She had a history of total thyroidectomy five years ago for papillary thyroid carcinoma, during which inadvertent removal of the parathyroid glands occurred, leading to the development of hypoparathyroidism. Since then, she had been experiencing fluctuating symptoms of hypocalcemia despite receiving calcium supplementation.
Clinical Presentation: On examination, Sarah appeared fatigued, with a notable Chvostek sign (facial twitching upon tapping the facial nerve) and Trousseau sign (carpal spasm induced by inflating a blood pressure cuff above systolic pressure). Laboratory investigations revealed hypocalcemia (serum calcium: 7.5 mg/dL, normal range: 8.5-10.5 mg/dL), hyperphosphatemia (serum phosphate: 5.0 mg/dL, normal range: 2.5-4.5 mg/dL), and low levels of intact parathyroid hormone (iPTH: < 5 pg/mL, normal range: 10-65 pg/mL).
Treatment Plan: Based on the clinical presentation and laboratory findings, Sarah was diagnosed with symptomatic hypoparathyroidism. The treatment plan aimed to restore calcium homeostasis and alleviate her symptoms. She was prescribed oral calcium carbonate (1,000 mg three times daily) in conjunction with calcitriol supplementation.
Calcitriol Therapy: Sarah started calcitriol therapy with an initial dose of 0.25 mcg twice daily, which was titrated based on her serum calcium levels and symptoms. Regular monitoring of serum calcium, phosphate, and renal function was scheduled every two weeks initially, then monthly once stabilization was achieved. Sarah was educated about the importance of adherence to medication, symptoms of hypercalcemia, and the need for dietary calcium intake.
Follow-Up: Over the subsequent weeks, Sarah’s symptoms improved gradually with the optimization of calcitriol therapy. Her serum calcium levels stabilized within the normal range (8.5-10.5 mg/dL), and she reported a significant reduction in muscle cramps and tingling sensations. However, she experienced transient episodes of hypercalcemia (serum calcium: 10.8 mg/dL) necessitating dose adjustments and closer monitoring. With careful titration and regular follow-up, Sarah achieved optimal control of her symptoms without significant adverse effects.
Long-Term Management: Sarah’s long-term management plan involved continued calcitriol therapy, calcium supplementation, and regular monitoring to prevent recurrence of hypocalcemic symptoms and complications. She was advised to maintain adequate hydration, avoid excessive intake of calcium-rich foods, and adhere to scheduled follow-up appointments for ongoing evaluation of treatment efficacy and safety.
Discussion: This case illustrates the challenges and complexities associated with managing hypoparathyroidism, a rare endocrine disorder characterized by impaired calcium metabolism. Calcitriol therapy, in combination with calcium supplementation, remains the cornerstone of treatment for restoring hormonal balance and alleviating symptoms of hypocalcemia. Individualized dosage titration and close monitoring are essential to achieve optimal outcomes while minimizing the risk of complications such as hypercalcemia and renal impairment.
Conclusion: Effective management of hypoparathyroidism requires a multidisciplinary approach involving endocrinologists, primary care physicians, and patients themselves. Through personalized treatment strategies, including calcitriol therapy, patients like Sarah can achieve improved quality of life and long-term well-being despite the challenges posed by this chronic condition.
Case Study: Management of Hyperparathyroidism with Calcitriol
