RESUMEN
CASE DESCRIPTION: A 4-year-old castrated male domestic ferret (Mustela putorius furo) was examined because of a 3-week history of intermittent seizures, signs of depression, hypocalcemia, and hyperphosphatemia. CLINICAL FINDINGS: Plasma biochemical analysis confirmed hyperphosphatemia (17.7 mg/dL) and low concentrations of total (4.3 mg/dL) and ionized (0.49 mmol/L) calcium. Serum parathyroid hormone concentration (2.30 pmol/L) was low or in the low part of the reference interval. TREATMENT AND OUTCOME: Calcium gluconate was administered (2.0 mg/kg/h [0.9 mg/lb/h], IV), followed by a transition to administration of calcium carbonate (53 mg/kg [24.1 mg/lb], PO, q 12 h) and dihydrotachysterol (0.02 mg/kg/d [0.009 mg/lb/d], PO). Attitude of the ferret improved and seizures ceased as blood calcium concentrations increased. The ferret was reexamined because of seizures approximately 1 year after oral maintenance administration of dihydrotachysterol and calcium was initiated. The ferret responded well to emergency and long-term treatment but then was lost to follow-up monitoring. The ferret died approximately 2 years after the initial evaluation and treatment. Hypertrophic cardiomyopathy was diagnosed during necropsy, but the parathyroid glands could not be identified. CLINICAL RELEVANCE: To the authors' knowledge, primary hypoparathyroidism has not previously been reported in a ferret. The condition should be considered for ferrets with hypocalcemia and hyperphosphatemia without azotemia. Treatment with dihydrotachysterol and oral supplementation of calcium appeared to be a viable option for long-term management.
Asunto(s)
Carbonato de Calcio/uso terapéutico , Gluconato de Calcio/uso terapéutico , Dihidrotaquisterol/uso terapéutico , Hurones , Hipoparatiroidismo/veterinaria , Vitaminas/uso terapéutico , Animales , Carbonato de Calcio/administración & dosificación , Gluconato de Calcio/administración & dosificación , Dihidrotaquisterol/administración & dosificación , Hipocalcemia/veterinaria , Hipoparatiroidismo/sangre , Hipoparatiroidismo/tratamiento farmacológico , Masculino , Vitaminas/administración & dosificaciónAsunto(s)
Hipercalcemia , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Calcio/sangre , Carcinoma Papilar/cirugía , Diagnóstico Diferencial , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Sobredosis de Droga , Femenino , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Hospitalización , Humanos , Hipercalcemia/inducido químicamente , Hipercalcemia/diagnóstico , Hipercalcemia/tratamiento farmacológico , Hipercalcemia/terapia , Hipoparatiroidismo/tratamiento farmacológico , Hipoparatiroidismo/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Pronóstico , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tiroxina/administración & dosificación , Tiroxina/efectos adversos , Tiroxina/uso terapéutico , Factores de TiempoAsunto(s)
Encefalopatías/inducido químicamente , Calcinosis/inducido químicamente , Calcio/efectos adversos , Dihidrotaquisterol/efectos adversos , Hipoparatiroidismo/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Anciano , Encefalopatías/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Calcio/administración & dosificación , Dihidrotaquisterol/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , TiroidectomíaRESUMEN
Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.
Asunto(s)
Glándulas Paratiroides/trasplante , Tiroidectomía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carbonato de Calcio/administración & dosificación , Carbonato de Calcio/uso terapéutico , Niño , Preescolar , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Ergocalciferoles/administración & dosificación , Ergocalciferoles/uso terapéutico , Estudios de Seguimiento , Humanos , Hipocalcemia/sangre , Hipocalcemia/tratamiento farmacológico , Hipocalcemia/etiología , Hipoparatiroidismo/tratamiento farmacológico , Hipoparatiroidismo/etiología , Persona de Mediana Edad , Músculos del Cuello/cirugía , Fosfatos/sangre , Tiroidectomía/métodos , Trasplante AutólogoAsunto(s)
Daño Encefálico Crónico/tratamiento farmacológico , Carbonato de Calcio/administración & dosificación , Trastornos del Conocimiento/tratamiento farmacológico , Dihidrotaquisterol/administración & dosificación , Hipoparatiroidismo/tratamiento farmacológico , Pruebas Neuropsicológicas , Antipsicóticos/administración & dosificación , Daño Encefálico Crónico/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Calcinosis/tratamiento farmacológico , Trastornos del Conocimiento/diagnóstico por imagen , Quimioterapia Combinada , Humanos , Hipoparatiroidismo/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The metabolism of 25-hydroxydihydrotachysterol3 (25-OH-DHT3) to more polar metabolites was investigated in vivo in the rat and compared with the in vitro metabolism of 1 alpha,25-dihydroxy-DHT3 (1 alpha,25-(OH)2DHT3) in the osteosarcoma cell line UMR 106. Rats were given 2 mg of DHT3 in divided doses at 0 and 6 hr. Plasma was collected 24 hr after the initial dose, extracted, separated, and polar metabolites purified by HPLC. A number of polar metabolites were formed in vivo with mass spectrometric characteristics which suggested that they were derived from a previously isolated metabolite of 25-OH-DHT3, T3/H. Of these, four were isolated and identified as 24-oxo-T3/H, 24-hydroxy-T3/H, 26-hydroxy-T3/H and the 26,23-lactone of T3/H. In view of the identification of T3/H as a mixture of 1 alpha- and 1 beta-hydroxylated 25-OH-DHT3, osteosarcoma cells (UMR 106) were incubated with chemically synthesized 1 alpha,25-(OH)2DHT3 in an attempt to determine from which component of the T3/H mixture these metabolites were derived. Again, more polar metabolites were formed and five of these were isolated by lipid extraction, purified by HPLC and identified as 24-oxo-1 alpha,25-(OH)2DHT3, 1 alpha,23,25-(OH)3DHT3, 24-oxo-1 alpha,23,25-(OH)3DHT3, 1 alpha,24,25-(OH)3DHT3 and 1 alpha,25,26-(OH)3DHT3. Three of the in vitro metabolites were similar to those found in rat plasma but only two of these metabolites were available in sufficient amounts to allow comparison. The chromatographic characteristics, using HPLC and gas chromatography, of these two pairs of metabolites (24-oxo and 24-hydroxy) were examined and it was demonstrated that they were not the same. It is therefore suggested that the polar metabolites formed in vivo are in fact metabolites of the T3/Hb component (1 beta,25-(OH)2DHT3) rather than the T3/Ha component (1 alpha,25-(OH)2DHT3). Supporting evidence for this suggestion was obtained when a small quantity of 1 beta,25-(OH)2DHT3, obtained from chemically synthesized 1 beta-OH-DHT3 by incubation with Hep 3B cells, was further incubated in the osteosarcoma UMR 106 system. Preliminary studies indicated that the putative 24-oxo and 24-hydroxy metabolites formed from 1 beta,25-(OH)2DHT3 had chromatographic and mass spectral properties almost indistinguishable from those of corresponding metabolites of T3/H formed in vivo. All the metabolites formed in vivo and in vitro are components of two metabolic pathways described previously for 25-hydroxyvitamin D3 and also for 25-OH-DHT3.
Asunto(s)
Dihidrotaquisterol/análogos & derivados , Animales , Línea Celular/metabolismo , Cromatografía Líquida de Alta Presión , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/química , Dihidrotaquisterol/metabolismo , Femenino , Cromatografía de Gases y Espectrometría de Masas , Hidroxilación , Masculino , Ratas , Ratas EndogámicasRESUMEN
We treated a hypoparathyroid woman with calcitriol during pregnancy and did not reduce the dosage after delivery. Despite lactation, the serum calcium level increased to 15.4 mg/dL 11 days postpartum. We treated two other hypoparathyroid women during four pregnancies with either calcitriol or dihydrotachysterol. In all five pregnancies, requirements for the vitamin D preparations increased beginning at the 20-28th week of gestation. Hypercalcemia did not occur in the two women who did not breast-feed and in whom we reduced the dose of calcitriol or dihydrotachysterol after delivery. We conclude the following: 1) Calcitriol is effective for treating hypoparathyroidism during pregnancy; 2) the dose usually needs to be increased during the latter half of gestation; 3) the calcitriol dose should be reduced during lactation; and 4) both mother and infant should be monitored to detect hypercalcemia during breast-feeding. We speculate that low serum estrogen levels associated with breast-feeding promote bone resorption and diminish calcitriol needs in lactating hypoparathyroid women.
Asunto(s)
Calcitriol/efectos adversos , Calcio/sangre , Dihidrotaquisterol/efectos adversos , Hipoparatiroidismo/tratamiento farmacológico , Lactancia , Complicaciones del Embarazo , Administración Oral , Adulto , Calcitriol/administración & dosificación , Calcitriol/uso terapéutico , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Femenino , Humanos , Hipoparatiroidismo/sangre , Hipotiroidismo/sangre , Hipotiroidismo/tratamiento farmacológico , Lactancia/sangre , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/tratamiento farmacológicoRESUMEN
The effect of administration of 25 micrograms 24,25-dihydroxyvitamin D3 (24,25(OH)2D) combined with dihydrotachysterol (DHT2) on clinical, radiological, biochemical and bone histological parameters was assessed in ten children on chronic hemodialysis. Eight children had been treated with DHT2 prior to administration of 24,25(OH)2D. Addition of 24,25(OH)2D to the treatment resulted in a decrease in serum calcium values. Therefore higher doses of DHT2 were required to maintain serum-calcium levels between 2.4-2.8 mmol/l. Administration of 24,25(OH)2D did not modify the quality of bone, but histomorphometric investigation did show a significant reduction of the surface percentage of bone trabecula, in the iliac crest, covered with osteoclasts (oc%). Following the administration of 24,25(OH)2D an increase in bone mineralization was shown by X-rays of the wrists and measured by dual photonabsorptiometry. Addition of 24,25(OH)2D to the DHT2 treatment resulted in an increase in serum concentration of 24,25(OH)2D and a decrease in DHT2 levels. The present study suggests that administered 24,25(OH)2D interferes with DHT2 metabolism and increases DHT2 tolerance. Increased bone mineralization may be related to 24,25(OH)2D, a higher dose of DHT2 or both.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Dihidrotaquisterol/uso terapéutico , Dihidroxicolecalciferoles/uso terapéutico , 24,25-Dihidroxivitamina D 3 , Adolescente , Huesos/análisis , Calcio/sangre , Niño , Preescolar , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/metabolismo , Dihidrotaquisterol/administración & dosificación , Dihidroxicolecalciferoles/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Minerales/análisis , Diálisis RenalRESUMEN
The distribution of radioactivity in serum of male rats (275 g) after oral administration of tritium labelled (5E)-(10S)-10,19-dihydroercalciol (dihydrotachysterol2) has been studied as a function of time and dose level. Nine distinct radioactive substances, chromatographing in the range between calciol and calcitriol, could be demonstrated. No attempt was made to establish chemical structures. After a single dose of 1.84 nmol, (5E)-(10S)-10,19-dihydroercalciol is very rapidly metabolized to more polar forms. The time course of appearance, ranging between 30 min and 1 day after administration, and the polarity of these substances indicated that they might be formed in sequence. The highest serum concentrations of the major substances occurred between 2 h and 10 h after administration, but compared with the dosage they were very low. In response to daily administration the concentrations of the major substances achieved steady-state levels within 1-4 days. The metabolism of (5E)-(10S)-10,19-dihydroercalciol was apparently not affected by its nutritional status at the dose level studied. After single administration of progressively increasing doses, ranging from 1.84 nmol to 1.84 mumol, the relative increments of the concentrations of the major substances rose in proportion to the relative increases of the dosage. The mechanisms responsible for the appearance of these substances in serum were found to be closely related. At dose levels up to 18.4 nmol feedback control was apparently absent.
Asunto(s)
Dihidrotaquisterol/sangre , Administración Oral , Animales , Dihidrotaquisterol/administración & dosificación , Absorción Intestinal , Masculino , Tasa de Depuración Metabólica , Ratas , Ratas EndogámicasRESUMEN
We treated 24 patients who had chronic renal insufficiency and renal osteodystrophy with either calcitriol (1,25-dihydroxyvitamin D3) or dihydrotachysterol. Renal function was evaluated before and during treatment to determine if these vitamin D analogues caused an accelerated rate of renal function deterioration. An accelerated rate of increase in the serum creatinine level was found in three of 12 patients in each treatment group after therapy was started, but the mean rate of increase during treatment did not differ significantly from the rate during the pretreatment control period in either group. The occurrence of hypercalcemia or an excessive serum calcium x phosphorus-product did not correlate with the rate of change in renal function during treatment with either drug. We concluded that children receiving calcitriol are not at greater risk for an accelerated rate of renal function deterioration than are children treated with dihydrotachysterol. Furthermore, neither vitamin D analogue could be directly implicated as a cause of an accelerated rate of renal function deterioration when episodes of hypercalcemia were transient and occurred infrequently.
Asunto(s)
Calcitriol/efectos adversos , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Dihidrotaquisterol/efectos adversos , Fallo Renal Crónico/fisiopatología , Riñón/fisiopatología , Adolescente , Adulto , Calcitriol/administración & dosificación , Calcitriol/uso terapéutico , Calcio/sangre , Niño , Preescolar , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/sangre , Creatinina/sangre , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Humanos , Hipercalcemia/inducido químicamente , Lactante , Riñón/efectos de los fármacos , Fallo Renal Crónico/sangre , Fósforo/sangre , Estudios Retrospectivos , RiesgoRESUMEN
Fifteen patients with dialysis osteomalacia were treated with 24,25-dihydroxyvitamin D3 in dosages up to 10 micrograms per day for two to 24 months. All had previously had no improvement during treatment with calcitriol but had been remarkably susceptible to hypercalcemia. When 24,25-dihydroxyvitamin D3 was given with either calcitriol or dihydrotachysterol, serum calcium levels were significantly lower than during treatment with calcitriol or dihydrotachysterol alone. Eight of nine patients who received combined therapy with 24,25-dihydroxyvitamin D3 and calcitriol for longer than two months had clinical improvement; six patients underwent repeated bone biopsy and showed evidence of improved bone mineralization. Patients who received 24,25-dihydroxyvitamin D3 alone did not improve clinically. Since 24,25-dihydroxyvitamin D3 appears to improve calcium homeostasis and bone mineralization in some patients with severe dialysis osteomalacia when administered with 1-hydroxylated vitamin D metabolites, further controlled studies are warranted.
Asunto(s)
Dihidroxicolecalciferoles/uso terapéutico , Osteomalacia/tratamiento farmacológico , Diálisis Renal/efectos adversos , 24,25-Dihidroxivitamina D 3 , Adulto , Fosfatasa Alcalina/sangre , Biopsia , Resorción Ósea , Calcitriol/administración & dosificación , Calcitriol/uso terapéutico , Calcio/sangre , Preescolar , Ensayos Clínicos como Asunto , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Dihidroxicolecalciferoles/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Osteomalacia/etiología , Factores de TiempoAsunto(s)
Periodontitis/cirugía , Periodoncio/anatomía & histología , Adulto , Materiales Biocompatibles/uso terapéutico , Trasplante Óseo , Citratos/administración & dosificación , Ácido Cítrico , Dentina/trasplante , Dihidrotaquisterol/administración & dosificación , Compuestos Férricos/administración & dosificación , Humanos , Periodoncio/fisiología , Permanganato de Potasio/administración & dosificación , Esclerótica/trasplante , Cicatrización de HeridasRESUMEN
Failure to diagnose and treat hypophosphatemic rickets during childhood resulted in stunted growth and progressive deformities of the lower limb. When the deformities were treated surgically, recurrent deformity and non-union of osteotomies developed, and further major opeative procedures were required to remedy these complications. Treatment from early childhood with oral phosphate and vitamin D improved the rate of growth and controlled the progression of bowleg deformity. Residual varus deformity was corrected by osteotomy through the proximal tibial metaphysis at skeletal maturity, when the results were predictable. Genu valgum deformity was corrected by stapling the medial part of the distal femoral epiphysis prior to skeletal maturity. With early postoperative mobilization and adequate medication, the complications of delayed tibial union and failure to correct the femoral valgus deformity were avoided.
Asunto(s)
Colecalciferol/administración & dosificación , Hipofosfatemia Familiar/complicaciones , Hipofosfatemia Familiar/terapia , Fosfatos/administración & dosificación , Administración Oral , Adolescente , Adulto , Niño , Dihidrotaquisterol/administración & dosificación , Femenino , Crecimiento , Humanos , Hipofosfatemia Familiar/etiología , Hipofosfatemia Familiar/fisiopatología , Masculino , OsteotomíaRESUMEN
The anabolic effect of steroid hormones was investigated in rabbits by measuring the skeletal accumulation rate of 85Sr following the continuous administration of estrogens, androgens and corticosteroids over a period of eight weeks. Androgenic hormones did not influence the accumulation rate of 85Sr, whereas following castration and prolonged administration of estrogens an increase of 85Sr accumulation was found. There was no correlation of the changes observed with serum calcium levels, since the latter remained stable throughout the observation period during long-term administration of various hormones.
Asunto(s)
Anabolizantes/metabolismo , Animales , Castración , Dihidrotaquisterol/administración & dosificación , Etinilestradiol/administración & dosificación , Femenino , Cinética , Masculino , Metenolona/administración & dosificación , Metilprednisolona/administración & dosificación , Conejos , Radioisótopos de Estroncio , Factores de Tiempo , Recuento Corporal TotalAsunto(s)
Seudohipoparatiroidismo/tratamiento farmacológico , Vitamina D/administración & dosificación , Adulto , Niño , Dihidrotaquisterol/administración & dosificación , Dihidrotaquisterol/uso terapéutico , Dihidroxicolecalciferoles/administración & dosificación , Dihidroxicolecalciferoles/uso terapéutico , Ergocalciferoles/administración & dosificación , Ergocalciferoles/uso terapéutico , Humanos , Masculino , Vitamina D/uso terapéuticoRESUMEN
The effects of oral administration of calcium carbonate, aluminum hydroxide gel, dihydrotachysterol (DHT) and sodium bicarbonate on metabolic acidosis and plasma calcium and phosphate were studied in 7 patients with chronic renal failure. Single administration of calcium carbonate alleviated the acidosis and increased the urinary bicarbonate excretion. These effects were potentiated when aluminum hydroxide gel was administered in combination with calcium carbonate. The plasma calcium was increased by this combination therapy. The effects of these two agents on acidosis and plasma calcium were further enhanced by the additional administration of DHT. Urinary bicarbonate excretion was less during the treatment with aluminum hydroxide gel and calcium carbonate than with aluminum hydroxide gel and sodium bicarbonate, when the excretions were compared at the similar concentrations of plasma bicarbonate. Aluminum hydroxide gel and DHT are likely to enhance the effect of calcium carbonate, which works as an alkalinizing salt on acidosis, probably through increasing calcium absorption in the intestine. And the three agents suppress the leak of bicarbonate into the urine contributing to the improvement of acidosis.