Causes and Differential Diagnosis of Hypocalcemia —Recommendation Proposed by Expert Panel Supported by Ministry of Health, Labour and Welfare, Japan—

Endocrine Journal

Noriyuki NAMBA³  Toshimi MICHIGAMI¹  Itsuro ENDO⁸  Daisuke INOUE⁶  Mika YAMAUCHI⁴  Masanori MINAGAWA⁵  Seiji FUKUMOTO²  Toshio MATSUMOTO⁸  Keiichi OZONO³  Hiroyuki TANAKA⁷  Toshitsugu SUGIMOTO⁴ 

[1]Department of Bone and Mineral Research, Osaka Medical Centre for Maternal and Child Health

[2]Division of Nephrology & Endocrinology, Department of Medicine, University of Tokyo Hospital

[3]Department of Pediatrics, Osaka University Graduate School of Medicine

[4]Department of Endocrinology/Metabolism and Hematology/Oncology, Shimane University School of Medicine

[5]Department of Pediatrics, Chiba University Graduate School of Medicine

[6]Third Department of Medicine, Teikyo University School of Medicine Ichihara Hospital

[7]Department of Pediatrics, Okayama University Graduate School of Medicine and Dentistry

[8]Department of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Medical Sciences

关键词: Hypocalcemia;    Hypoparathyroidism;    Parathyroid hormone;    1;    25-dihydroxyvitamin D;   

DOI  :  10.1507/endocrj.K08E-076

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(44)Cited-By(7)Serum calcium (Ca) level is maintained within a narrow range mainly by actions of parathyroid hormone (PTH) and 1,25-dihydroxyvitmain D [1,25(OH)2D]. While it is not rare to encounter hypocalcemia in clinical practice, there is currently no practical guideline for the differential diagnosis of hypocalcemia. We therefore propose flowcharts for the differential diagnosis of hypocalcemia and hypoparathyroidism, especially PTH-deficient hypoparathyroidism in which many genetic or other causes have been identified recently. Hypocalcemia can be divided into two categories, hypocalcemia with low serum phosphate level, and one with normal to elevated serum phosphate level. Deficient actions of 1,25(OH)2D, loss of Ca into urine, and deposition of Ca in bone or soft tissues are main causes of hypocalcemia with low to low normal serum phosphate level. Hypocalcemia with high normal to high serum phosphate level includes chronic renal failure and hypoparathyroidism. Hypoparathyroidism is subdivided into PTH-deficient hypoparathyroidism and pseudohypoparathyroidism. Recent investigations identified several causes of PTH-deficient hypoparathyroidism, including genetic abnormalities and parathyroid autoantibodies, which should be differentiated from idiopathic hypoparathyroidism. Physical and laboratory findings, the time of the onset of diseases and accompanying illness can be clues for identifying causes of PTH-deficient hypoparathyroidism.

【 授权许可】

Unknown