title: Decreased calcitriol requirement during pregnancy and lactation with a window of increased requirement immediately post partum.
abstract: OBJECTIVE
  To describe the changes in calcium and calcitriol requirements during pregnancy and lactation in a patient with hypoparathyroidism due to autosomal dominant hypocalcemia.
  
  
  METHODS
  We summarize the clinical presentation and treatment of the patient and review the pertinent literature.
  
  
  RESULTS
  Calcitriol requirements disappeared during pregnancy in a 34-year-old woman with autosomal dominant hypoparathyroidism secondary to an activating mutation in the calcium-sensing receptor gene. Within hours after delivery, her serum calcium concentration dropped to 4.7 mg/dL (albumin, 3.2 g/dL), and she required intravenous calcium and reinstitution of calcitriol. When lactation began a few days later, her calcitriol requirement again disappeared. As has occasionally been described in the literature, this patient with hypoparathyroidism required no calcitriol during late pregnancy and lactation to maintain a normal serum calcium level.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case documenting a period of time between pregnancy and lactation when calcitriol requirements reappeared, likely due to a parathyroid hormone-related protein "window" between delivery, when placental production of parathyroid hormone-related protein stops, and lactation, when mammary gland production begins.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Sweeney
authors.forename: Alan O
authors.initials: AO
authors.lastname: Malabanan
authors.forename: Harold
authors.initials: H
authors.lastname: Rosen
mesh_terms: D002117:Calcitriol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000188:drug therapy*; D007774:Lactation / Q000502:physiology*; D049590:Postpartum Period; D011247:Pregnancy
chemical_list: D002117:Calcitriol