Clinical Review

Lesson of the week Oestrogen and calcium homeostasis in women with hypoparathyroidism

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7219.1252 (Published 06 November 1999) Cite this as: BMJ 1999;319:1252
  1. Janet McIlroy, specialist registrar ([email protected])a,
  2. Frances Dryburgh, consultanta,
  3. John Hinnie, lecturerb,
  4. Rosemary Dargie, clinical assistantb,
  5. Alaa Al-Rawi, senior house officerb
  1. a Department of Clinical Biochemistry, Macewen Building, Glasgow Royal Infirmary, Glasgow. G4 0SF
  2. b University Department of Medicine, Glasgow Royal Infirmary
  1. Correspondence to: J McIlroy
  • Accepted 12 May 1999

Oestrogen status can affect the requirement for vitamin D in women with hypoparathyroidism

Permanent hypoparathyroidism occurs in 0.2%-0.3% of patients who undergo thyroid surgery1; it arises less frequently as an inherited or as an autoimmune disease The condition is treated with vitamin D analogue drugs, doses of which have to be titrated against the serum calcium concentration while avoiding hypercalciuria. The vitamin D requirements in women with hypoparathyroidism can change if their oestrogen status alters An awareness of this can avoid hypercalcaemia.

Case reports

Case 1

A 54 year old woman had undergone thyroidectomy for Graves' disease 34 years previously and had been treated with vitamin D since that time. She had remained euthyroid, and her serum calcium concentration had been satisfactory and stable for several years on 1-α hydroxycholecalciferol treatment (1 μg/day). The patient's parathyroid hormone concentration was below the level of detection, although her calcitonin concentration was measurable (32 ng/l, reference range <45 ng/l). Two months after stopping hormone replacement therapy she developed symptoms of hypercalcaemia—anorexia, nausea, abdominal pain, constipation, and weight loss of 9 kg. Hypercalcaemia was confirmed biochemically; her calcium concentration, adjusted for …

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