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[The "needle man": more than 40,000 injections in 40 years]
S Schiekofer1, P Heilmann, P P Nawroth
1Medizinische Klinik I, Universität Heidelberg, Germany.
History And Admission Findings:
A now 65-year-old man had undergone a subtotal thyroidectomy over 40 years ago, which postoperatively resulted in hypoparathyroidism. His doctor began daily intravenous injections of a calcium preparation (1880 mg to 3760 mg calcium per day, over 40000 injections during this period), a regimen continued subsequently by a total of more than 15 other doctors for over 40 years. On admission the patient complained of oral paresthesias and paresthesias of the limbs.
Investigations:
Low calcium and parathormone levels confirmed the diagnosis of hypoparathyroidism.
Treatment And Course:
Normal levels of calcium were achieved after a short course of 1.25-dihydroxycalciferol. This was followed by the administration of cholecalciferol and calcium. The patient soon became symptom-free and calcium levels returned to normal. Late sequelae have been calcification of the basal ganglia, first signs of nephrocalcinosis and bilateral cataract.
Conclusion:
This case demonstrates that appropriate treatment of hypoparathyroidism [corrected] might not be given in every case.