title: Vitamin D insufficiency underlies unexpected hypocalcemia following high dose glucocorticoid therapy.
abstract: Vitamin D insufficiency is a reemerging and common health problem for skeletal system. Pharmacological application of glucocorticoid inhibits intestinal calcium absorption and stimulates tubular calcium excretion, thus induces severely negative calcium balance. We report a patient presenting symptomatic hypocalcemia following high dose glucocorticoid administration. After a pulse-therapy with methylprednisolone, hypocalcemia with muscle cramp developed in association with hypercalciuria and secondary hyperparathyroidism in the absence of hypomagnesemia. Circulating level of 1,25-dihydroxyvitamin D was in a reference range, while that of 25-hydroxyvitamin D was insufficient. Treatment with alfacalcidol of 1 mug/day promptly improved serum calcium level within a couple of weeks. Vitamin D insufficiency could be a serious problem in patients with high dose glucocorticoid therapy.
authors.affiliation: Toranomon Hospital Endocrine Center, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuoka
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeuchi
mesh_terms: D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000097:blood; D002118:Calcium / Q000097:blood; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced*; D015458:Leukemia, T-Cell / Q000601:surgery; D008223:Lymphoma / Q000601:surgery; D008875:Middle Aged; D010012:Osteogenesis; D010710:Phosphates / Q000097:blood; D014808:Vitamin D Deficiency / Q000188:drug therapy*
chemical_list: D015415:Biomarkers; D005938:Glucocorticoids; D010710:Phosphates; D002118:Calcium