糖皮质激素加重甲状旁腺功能减退症低钙血症一例

Glucocorticoids aggravate hypocalcemia in a patient with hypoparathyroidism:a case report

糖皮质激素可以导致负钙平衡,但很少导致临床上显著的低钙血症。本文报道一例中年特发性甲状旁腺功能减退症女性患者,长期服用钙剂和活性维生素D制剂治疗,患者在颈椎病围手术期使用甲强龙40至120 mg/d,血钙下降0.2至0.5 mmol/L、手足麻木症状加重,钙剂和骨化三醇加量后血钙仍改善不明显;停用甲强龙后,患者血钙逐渐升高至2.0 mmol/L。本文在复习相关文献基础上探索糖皮质激素对血钙的影响,旨在提醒临床医师糖皮质激素使用可加重甲状旁腺功能减退症患者低钙血症,需要及时识别和处理。

Glucocorticoids have negative effects on calcium balance,though they do not usually cause clinically significant hypocalcemia.We presented a case of a middle-aged woman with idiopathic hypoparathyroidism who received long-term oral calcium and active vitamin D supplementation,but developed severe hypocalcaemia(calcium decreased by 0.2 to 0.5 mmol/L)and numbness of limbs following administration of high-dose methylprednisolone(40 to 120 mg/d)during perioperative period of cervical myelopathy surgery.Increasing the dose of oral calcium and calcitriol could not prevent the development of hypocalcaemia.After discontinuation of methylprednisolone,serum calcium gradually increased to 2.0 mmol/L.We explored the effects of glucocorticoids on serum calcium based on the review of relevant literatures.This case reminds clinicians that glucocorticoids might aggravate hypocalcemia in patients with hypoparathyroidism,which needs to be recognized and treated timely.