Hypoparathyroidism is an abnormality of calcium metabolism characterized by low serum levels of parathyroid hormone in spite of hypocalcemia. The causes of hypoparathyroidism are numerous. Activating mutations in the calcium-sensing receptor (CaSR) gene are well-known causes of familial isolated hypoparathyroidism, also known as autosomal dominant hypocalcemia (ADH). Here we describe members of a Korean family with a heterozygous Pro221Leu mutation causing ADH. This case is the first report in Korea.
Bone Density Conservation Agents/therapeutic use ; Calcium Carbonate/therapeutic use ; Female ; Heterozygote ; Humans ; Hydroxycholecalciferols/therapeutic use ; Hypocalcemia/diagnosis/drug therapy/*genetics ; Mutation ; Parathyroid Hormone/analysis ; Pedigree ; Receptors, Calcium-Sensing/*genetics ; Republic of Korea ; Sequence Analysis, DNA ; Young Adult

The metastatic calcification is defined as the deposition of calcium salt in normal tissue with an abnormal serum biochemical environment, such as chronic kidney disease, hyperparathyroidism, and hypercalcemia related with malignancy. Although the metastatic calcification can develop in any organs and tissues, presenting its symptoms and complications are rare. Thus a few cases have been reported. This case shows the metastatic calcification of the small intestine without any peritoneal and mesenteric vascular calcification which was early diagnosed by computed tomography and mesenteric angiography in a patient with abdominal pain, receiving continuous ambulatory peritoneal dialysis due to end stage renal disease. The clinician should early consider the metastatic calcification as differential diagnosis when unidentified calcifications are noted in simple abdominal X-ray such as in the present case, and promptly confirm it by using appropriate diagnostic tests in order to prevent its complications and progression.
Calcinosis/*diagnosis/drug therapy/etiology ; Calcitriol/therapeutic use ; Calcium/blood ; Calcium Carbonate/therapeutic use ; Calcium Channel Agonists/therapeutic use ; Humans ; Intestine, Small/*radiography ; Kidney Failure, Chronic/therapy ; Male ; Mesenteric Artery, Superior/radiography ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Tomography, X-Ray Computed

BACKGROUNDRenal osteodystrophy is one of the commonest complications of chronic renal failure. It may have a severe impact on the quality of life of patients on maintenance dialysis therapy. Besides post-menopausal women and elderly people, the dialysis patients are another high risk group. But at present, there is no research on how to prevent osteoporosis in maintenance dialysis patients. This study was conducted to observe the bone density of maintenance dialysis patients and to evaluate the clinical outcomes and safety of different administration dosage of salmon calcitonin to prevent osteoporosis in maintenance dialysis patients.

METHODSOne hundred and forty-eight patients on maintenance dialysis were involved in the 12-month, randomized, controlled trial. Fifty patients (experiment I group) received subcutaneous injection of salmon calcitonin (50 U) three times a week for 12 months. Fifty patients (experiment II group) received subcutaneous injection of salmon calcitonin (100 U) three times a week for 12 months. At the same time, both of them received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 microg qn for 12 months. The control group only received oral calcium carbonate 1500 mg tid and rocaltrol 0.25 microg qn for 12 months. The levels of bone mass density (BMD) of the lumbar spine and femoral neck, serum intact parathyroid hormone (iPTH), osteocalcin (OC), calcium, phosphorus, alkaline phosphatase (ALP) were assessed at baseline and then again after 3, 6 and 12 months of treatment.

RESULTSThe values of BMD at the lumbar spine and femoral neck before the treatment were not significantly different from those 3, 6, and 12 months after the treatment in trial groups I and II (all P > 0.05) and there were no significant differences in the BMD values at different time points between trial groups I and II. In the control group, the BMD values at the lumbar spine and femoral neck 3, 6, and 12 months after the beginning of trial were significantly lower than those before the trial, and significantly lower than the corresponding values of trial groups I and II (all P < 0.05). The serum OC 3, 6, and 12 months after the treatment was significantly lower than that before the experiment (all P < 0.05) in the control group. However, there was no significant difference in the value of serum OC before and 3, 6, and 12 months after the treatment in trial groups I and II (all P > 0.05).

CONCLUSIONSThe dose of salmon calcitonin 50 U three times a week plus calcium carbonate and active vitamin D can effectively preserve the BMD and prevent bone loss in maintenance dialysis patients, and it is well tolerated by patients on maintenance dialysis.

Adult ; Alkaline Phosphatase ; blood ; Bone Density ; drug effects ; Bone Density Conservation Agents ; administration & dosage ; therapeutic use ; Calcitonin ; administration & dosage ; therapeutic use ; Calcium ; blood ; Calcium Carbonate ; administration & dosage ; therapeutic use ; Drug Administration Schedule ; Female ; Femur Neck ; drug effects ; metabolism ; Humans ; Lumbar Vertebrae ; drug effects ; metabolism ; Male ; Middle Aged ; Osteocalcin ; blood ; Osteoporosis, Postmenopausal ; blood ; prevention & control ; Parathyroid Hormone ; blood ; Phosphorus ; blood ; Renal Dialysis