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Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia
Repeated blood transfusions in transfusion dependent thalassemia (TDT) leads to iron overload-related endocrine complications. Hypoparathyroidism (HPT) with severe signs of hypocalcemia is a recognized complication among these patients. A 14-year-old thalassaemic boy, on regular transfusion and on a...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Journal of the ASEAN Federation of Endocrine Societies
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784244/ https://www.ncbi.nlm.nih.gov/pubmed/33442182 http://dx.doi.org/10.15605/jafes.035.01.23 |
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author | Majumder, Anirban Basu, Sagar |
author_facet | Majumder, Anirban Basu, Sagar |
author_sort | Majumder, Anirban |
collection | PubMed |
description | Repeated blood transfusions in transfusion dependent thalassemia (TDT) leads to iron overload-related endocrine complications. Hypoparathyroidism (HPT) with severe signs of hypocalcemia is a recognized complication among these patients. A 14-year-old thalassaemic boy, on regular transfusion and on anticonvulsant therapy with a presumptive diagnosis of epilepsy for the last 1 year, was admitted with high fever and severe muscle cramps with positive Trousseau’s sign. He was diagnosed as a case of primary HPT and magnesium deficiency on the basis of low serum calcium, high phosphate, normal alkaline phosphates, very low intact parathyroid hormone (iPTH), normal serum vitamin D and very low serum magnesium level. His calcium, magnesium and phosphate level normalised following treatment with intravenous magnesium and calcium. His iPTH improved but remained at low normal. He was discharged from hospital with oral calcium, calcitriol, and magnesium supplementation. The anticonvulsant (Phenobarbitone) was successfully withdrawn gradually over the next six months without any recurrence of seizure in the subsequent 3 years of follow up. Acquired HPT (apparently from hemosiderosis) is a common cause of hypocalcemia; and magnesium depletion further complicated the situation leading to severe hypocalcemia with recurrent episodes of convulsion. Magnesium replacement improved the parathyroid hormone (PTH) value proving its role in acquired HPT. Very high phosphate level on admission and poor PTH response with respect to the low serum calcium, indicates intrinsic parathyroid pathology. Metabolic abnormalities should always be evaluated in thalassaemic subject with seizure disorder and it appears that the initial convulsive episodes were due to hypocalcemia. Muscle pain, cramps or convulsion may occur from HPT and simultaneous magnesium deficiency in transfusion dependent thalassaemic subjects. Metabolic correction is more important than anticonvulsant medication. Calcium and magnesium should both be assessed routinely in transfusion dependent thalassemic patients. |
format | Online Article Text |
id | pubmed-7784244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Journal of the ASEAN Federation of Endocrine Societies |
record_format | MEDLINE/PubMed |
spelling | pubmed-77842442021-01-12 Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia Majumder, Anirban Basu, Sagar J ASEAN Fed Endocr Soc Case Report Repeated blood transfusions in transfusion dependent thalassemia (TDT) leads to iron overload-related endocrine complications. Hypoparathyroidism (HPT) with severe signs of hypocalcemia is a recognized complication among these patients. A 14-year-old thalassaemic boy, on regular transfusion and on anticonvulsant therapy with a presumptive diagnosis of epilepsy for the last 1 year, was admitted with high fever and severe muscle cramps with positive Trousseau’s sign. He was diagnosed as a case of primary HPT and magnesium deficiency on the basis of low serum calcium, high phosphate, normal alkaline phosphates, very low intact parathyroid hormone (iPTH), normal serum vitamin D and very low serum magnesium level. His calcium, magnesium and phosphate level normalised following treatment with intravenous magnesium and calcium. His iPTH improved but remained at low normal. He was discharged from hospital with oral calcium, calcitriol, and magnesium supplementation. The anticonvulsant (Phenobarbitone) was successfully withdrawn gradually over the next six months without any recurrence of seizure in the subsequent 3 years of follow up. Acquired HPT (apparently from hemosiderosis) is a common cause of hypocalcemia; and magnesium depletion further complicated the situation leading to severe hypocalcemia with recurrent episodes of convulsion. Magnesium replacement improved the parathyroid hormone (PTH) value proving its role in acquired HPT. Very high phosphate level on admission and poor PTH response with respect to the low serum calcium, indicates intrinsic parathyroid pathology. Metabolic abnormalities should always be evaluated in thalassaemic subject with seizure disorder and it appears that the initial convulsive episodes were due to hypocalcemia. Muscle pain, cramps or convulsion may occur from HPT and simultaneous magnesium deficiency in transfusion dependent thalassaemic subjects. Metabolic correction is more important than anticonvulsant medication. Calcium and magnesium should both be assessed routinely in transfusion dependent thalassemic patients. Journal of the ASEAN Federation of Endocrine Societies 2020-04-28 2020 /pmc/articles/PMC7784244/ /pubmed/33442182 http://dx.doi.org/10.15605/jafes.035.01.23 Text en © 2020 Journal of the ASEAN Federation of Endocrine Societies https://creativecommons.org/licenses/by-nc/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. |
spellingShingle | Case Report Majumder, Anirban Basu, Sagar Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title | Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title_full | Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title_fullStr | Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title_full_unstemmed | Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title_short | Hypoparathyroidism in a Case of Transfusion Dependent Thalassemia |
title_sort | hypoparathyroidism in a case of transfusion dependent thalassemia |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784244/ https://www.ncbi.nlm.nih.gov/pubmed/33442182 http://dx.doi.org/10.15605/jafes.035.01.23 |
work_keys_str_mv | AT majumderanirban hypoparathyroidisminacaseoftransfusiondependentthalassemia AT basusagar hypoparathyroidisminacaseoftransfusiondependentthalassemia |