1. Successful Intermittent Intravenous Calcium Treatment via the Peripheral Route in a Patient with Hereditary Vitamin D-Resistant Rickets and Alopecia
- Author
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Seniha Kiremitci, Tsuyoshi Isojima, Sachiko Kitanaka, and Betül Ersoy
- Subjects
Male ,Vitamin ,medicine.medical_specialty ,Calcitriol ,Endocrinology, Diabetes and Metabolism ,chemistry.chemical_element ,Rickets ,Calcium ,Calcitriol receptor ,Gastroenterology ,Drug Administration Schedule ,chemistry.chemical_compound ,Endocrinology ,Internal medicine ,medicine ,Humans ,Hyperparathyroidism ,business.industry ,Genetic disorder ,Alopecia ,medicine.disease ,Familial Hypophosphatemic Rickets ,Treatment Outcome ,chemistry ,Child, Preschool ,Mutation ,Pediatrics, Perinatology and Child Health ,Receptors, Calcitriol ,Administration, Intravenous ,business ,medicine.drug - Abstract
Background: Hereditary vitamin D-resistant rickets (HVDRR) is a rare genetic disorder caused by mutations in the vitamin D receptor (VDR) gene, which result in end-organ resistance to 1,25-(OH)2D3. Patients with HVDRR are mostly treated using i.v. calcium therapy with a central catheter. However, central catheter-related complications have been reported. Patient: The patient was a 3-year-old boy presenting with waddling gait and alopecia. He had hypocalcemia [8 mg/dl (2 mmol/l)], hyperparathyroidism (1,232 ng/l), and elevated 1,25-(OH)2D3 levels (>250 pmol/l). DNA sequence analyses of the VDR gene showed a homozygous C-T transition at codon 152, resulting in a non-sense mutation in exon 5. Interventions and Outcomes: The patient was initially treated with calcitriol (80 ng/kg/day) and high-dose oral calcium (150 mg/kg/day) for one year. At the end of the first year, intermittent (5 days per month) i.v. calcium therapy without a central catheter was initiated because of insufficient clinical and radiological improvement. After 2 years of intermittent i.v. calcium therapy, there was a clear improvement based on clinical progress and on X-ray and biochemical findings. No peripheral complications were reported either. Conclusion: HVDRR with a non-sense mutation in the ligand-binding domain and alopecia was successfully treated with intermittent i.v. calcium without a central catheter.
- Published
- 2015