PDF(Pubmed)
Abstract：
BACKGROUND: Transient hypercalcaemia due to teriparatide occurs in up to 11% of patients though delayed hypercalcaemia (> 24 h post injection) is rare. We report the case of a female who developed significant delayed hypercalcaemia after teriparatide treatment for osteoporosis and review other cases in the literature to date.
METHODS: A 72-year-old female on teriparatide for the treatment of osteoporosis was found to have hypercalcaemia (3.30 mmol/l) on routine testing approximately 3 months after starting therapy. Serum calcium pretreatment was normal at 2.39 mmol/l. She was admitted to the hospital for investigations which identified a serum 25-hydroxyvitamin D of 94 nmol/l, a low parathyroid hormone of 6.0 pg/ml, and normal test results for 1,25 dihydroxyvitamin D (115 pmol/l), parathyroid hormone-related peptide (< 1.4 pmol/ml), serum electrophoresis and angiotensin-converting enzyme (39 IU/l). CT abdomen, pelvis, and thorax revealed no evidence of malignancy and an isotope bone scan ruled out skeletal metastases. Serum calcium normalised (2.34 mmol/l) several days after stopping teriparatide and calcium supplements and administering intravenous fluid. On restarting teriparatide, delayed hypercalcaemia reoccurred and treatment was switched to denosumab.
CONCLUSIONS: Delayed moderate to severe hypercalcaemia (serum calcium > 3.0 mmol/l) due to teriparatide is rare but may lead to therapy withdrawal. The underlying predisposing risk factors remain unclear and highlight the importance of a routine serum calcium assessment on therapy.
METHODS: A 72-year-old female on teriparatide for the treatment of osteoporosis was found to have hypercalcaemia (3.30 mmol/l) on routine testing approximately 3 months after starting therapy. Serum calcium pretreatment was normal at 2.39 mmol/l. She was admitted to the hospital for investigations which identified a serum 25-hydroxyvitamin D of 94 nmol/l, a low parathyroid hormone of 6.0 pg/ml, and normal test results for 1,25 dihydroxyvitamin D (115 pmol/l), parathyroid hormone-related peptide (< 1.4 pmol/ml), serum electrophoresis and angiotensin-converting enzyme (39 IU/l). CT abdomen, pelvis, and thorax revealed no evidence of malignancy and an isotope bone scan ruled out skeletal metastases. Serum calcium normalised (2.34 mmol/l) several days after stopping teriparatide and calcium supplements and administering intravenous fluid. On restarting teriparatide, delayed hypercalcaemia reoccurred and treatment was switched to denosumab.
CONCLUSIONS: Delayed moderate to severe hypercalcaemia (serum calcium > 3.0 mmol/l) due to teriparatide is rare but may lead to therapy withdrawal. The underlying predisposing risk factors remain unclear and highlight the importance of a routine serum calcium assessment on therapy.
摘要：
背景：由于特立帕肽导致的短暂性高钙血症在高达11%的患者中发生，尽管迟发性高钙血症（注射后>24小时）是罕见的。我们报告了一例女性，该女性在特立帕肽治疗骨质疏松症后出现了明显的迟发性高钙血症，并回顾了迄今为止文献中的其他病例。
方法：一名72岁女性服用特立帕肽治疗骨质疏松症，在开始治疗后约3个月的常规检查中发现高钙血症（3.30mmol/l）。血清钙预处理正常，为2.39mmol/l。她被送进医院进行调查，发现血清25-羟基维生素D为94nmol/l，6.0pg/ml的低甲状旁腺激素，和1,25二羟维生素D（115pmol/l）的正常测试结果，甲状旁腺激素相关肽（<1.4pmol/ml），血清电泳和血管紧张素转换酶（39IU/l）。腹部CT,骨盆,胸部没有发现恶性肿瘤的证据，同位素骨扫描排除了骨骼转移。停用特立帕肽和钙补充剂并给予静脉输液后几天，血清钙恢复正常（2.34mmol/l）。在重新启动特立帕肽时，迟发性高钙血症复发，治疗改用denosumab。
结论：特立帕肽导致的中度至重度高钙血症（血清钙>3.0mmol/l）的延迟很少见，但可能导致停药。潜在的诱发风险因素仍不清楚，并强调了常规血清钙评估对治疗的重要性。
方法：一名72岁女性服用特立帕肽治疗骨质疏松症，在开始治疗后约3个月的常规检查中发现高钙血症（3.30mmol/l）。血清钙预处理正常，为2.39mmol/l。她被送进医院进行调查，发现血清25-羟基维生素D为94nmol/l，6.0pg/ml的低甲状旁腺激素，和1,25二羟维生素D（115pmol/l）的正常测试结果，甲状旁腺激素相关肽（<1.4pmol/ml），血清电泳和血管紧张素转换酶（39IU/l）。腹部CT,骨盆,胸部没有发现恶性肿瘤的证据，同位素骨扫描排除了骨骼转移。停用特立帕肽和钙补充剂并给予静脉输液后几天，血清钙恢复正常（2.34mmol/l）。在重新启动特立帕肽时，迟发性高钙血症复发，治疗改用denosumab。
结论：特立帕肽导致的中度至重度高钙血症（血清钙>3.0mmol/l）的延迟很少见，但可能导致停药。潜在的诱发风险因素仍不清楚，并强调了常规血清钙评估对治疗的重要性。
