title: Decreased parathyroid hormone levels despite persistent hypocalcemia in patients with kidney failure recovering from septic shock.
abstract: BACKGROUND
  Hypocalcemia is a common and poorly understood finding in critically ill patients. The current study was designed to assess the association of ionized calcium, vitamin D, phosphorus and Parathyroid hormone levels in a cohort of patients with and without kidney dysfunction admitted for sepsis or non-infectious causes.
  
  
  METHODS
  Prospective cohort clinical and biochemical study.
  
  
  RESULTS
  We confirmed that hypocalcemia and hypovitaminosis D are a common finding in critically ill patients. Parathyroid hormone levels significantly rise in septic shock. In the recovery phase, however, despite persistent hypocalcemia, Parathyroid hormone levels abruptly decrease in patients with kidney dysfunction, but not in patients with normal renal function.
  
  
  CONCLUSIONS
  The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.
authors.affiliation: Faculdade de Medicina da USP, Laboratorio de Emergencias Clinicas, Sao Paulo, SP, Brazil. pinheirofabiano@hotmail.com
authors.forename: Fabiano
authors.initials: F
authors.lastname: Pinheiro da Silva
authors.forename: Fernando Godinho
authors.initials: FG
authors.lastname: Zampieri
authors.forename: Hermes Vieira
authors.initials: HV
authors.lastname: Barbeiro
authors.forename: Francisco Torggler
authors.initials: FT
authors.lastname: Filho
authors.forename: Alessandra Carvalho
authors.initials: AC
authors.lastname: Goulart
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
authors.forename: Irineu Tadeu
authors.initials: IT
authors.lastname: Velasco
authors.forename: Luiz Monteiro
authors.initials: LM
authors.lastname: da Cruz Neto
authors.forename: Heraldo Possolo
authors.initials: HP
authors.lastname: de Souza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D012772:Shock, Septic / Q000097:blood* / Q000453:epidemiology / Q000534:rehabilitation
chemical_list: D010281:Parathyroid Hormone