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Neonatal hypocalcaemia associated with maternal hyperparathyroidism. New pathogenetic observations
Insights
Neonatal hypocalcaemic convulsions in infants can be linked to maternal hyperparathyroidism. Early treatment with active vitamin D may be necessary, especially when vitamin D conversion is impaired.
Area of Science:
- Pediatrics
- Endocrinology
- Neonatology
Background:
- Neonatal hypocalcemia is a critical condition requiring prompt diagnosis and management.
- Maternal hyperparathyroidism can impact fetal calcium homeostasis.
- Vitamin D metabolism plays a crucial role in calcium regulation.
Purpose of the Study:
- To investigate the relationship between maternal hyperparathyroidism and neonatal hypocalcemia.
- To explore the role of vitamin D metabolism in a case of neonatal hypocalcemic convulsions.
- To determine the optimal treatment strategy for such cases.
Main Methods:
- Case study of a 32-day-old male infant presenting with hypocalcemic convulsions.
- Analysis of serum calcium, phosphate, parathyroid hormone (PTH), and 25-hydroxycholecalciferol (25-OHD3) levels.
- Monitoring of biochemical parameters during treatment with calcium and vitamin D.
Main Results:
- The infant presented with severe hypocalcemia and hyperphosphatemia, alongside normal maternal parathyroid hormone and 25-hydroxycholecalciferol.
- Post-treatment, a marked increase in PTH and 25-OHD3 was observed before calcium normalization.
- This suggests a potential impairment in the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxyvitamin D3 during hyperphosphatemia.
Conclusions:
- Neonatal hypocalcemic convulsions can be associated with asymptomatic maternal hyperparathyroidism.
- Impaired vitamin D metabolism, specifically the conversion to the active form, may contribute to hypocalcemia in the neonatal period.
- Treatment with 1,25-dihydroxyvitamin D3 or its analogues is recommended for persistent or severe cases.
Abstract:
A 32-day-old male infant had hypocalcaemic convulsions associated with asymptomatic maternal hyperparathyroidism. Very low total and ionised serum calcium, increased serum phosphate, and normal serum parathyroid hormone (PTH) and 25-hydroxycholecalciferol (25-OHD3) concentrations were found at admission. After treatment with calcium and vitamin D, serum PTH and 25-OHD3 concentrations increased markedly before serum calcium levels returned to normal perhaps indicating an inability to convert 25-OHD3 to the metabolically active 1,25-dihyroxyvitamin D3 during the hyperphosphataemic state. Treatment with 1,25-dihdroxyvitamin D3 or its analogues is recommended.