Hypocalcemic disorders
Hypocalcemic disorders
复制标题
DOI：
10.1016/j.beem.2018.05.006
复制
发表时间：
2018-10-01
影响因子：
7.4
通讯作者：
Mannstadt, Michael
中科院分区：
文献类型：
--
作者：
Bove-Fenderson, Erin;Mannstadt, Michael
钙对生命至关重要，细胞外钙浓度必须始终保持在精确的浓度范围内。低血清钙（低钙血症）与多种疾病同时发生，严重时可危及生命。急性低钙血症的症状包括神经肌肉易激惹、手足抽搐和癫痫发作，静脉注射葡萄糖酸钙可迅速缓解。然而，导致慢性低钙血症的疾病往往有更微妙的表现。甲状旁腺功能减退，其特征在于甲状旁腺激素（PTH）分泌受损，甲状旁腺激素是维持钙稳态的关键调节激素，是慢性低钙血症的典型原因。破坏维生素D代谢的疾病也可能导致慢性低钙血症，因为维生素D负责增加膳食钙的肠道吸收。慢性低钙血症的治疗和管理选择因基础疾病而异。例如，在甲状旁腺功能减退的患者中，必须仔细滴定钙和维生素D补充剂，以避免低钙血症的症状，同时将血清钙保持在低正常范围内，以尽量减少可导致肾功能障碍的高钙尿症。慢性低钙血症的管理需要了解的因素，影响复杂的调节轴的钙稳态在一个给定的障碍。本章讨论了常见和罕见的低钙血症，症状和检查，以及管理方案，包括甲状旁腺功能减退症的PTH替代。(C)2018爱思唯尔有限公司版权所有。
Calcium is vital for life, and extracellular calcium concentrations must constantly be maintained within a precise concentration range. Low serum calcium (hypocalcemia) occurs in conjunction with multiple disorders and can be life-threatening if severe. Symptoms of acute hypocalcemia include neuromuscular irritability, tetany, and seizures, which are rapidly resolved with intravenous administration of calcium gluconate. However, disorders that lead to chronic hypocalcemia often have more subtle manifestations. Hypoparathyroidism, characterized by impaired secretion of parathyroid hormone (PTH), a key regulatory hormone for maintaining calcium homeostasis, is a classic cause of chronic hypocalcemia. Disorders that disrupt the metabolism of vitamin D can also lead to chronic hypocalcemia, as vitamin D is responsible for increasing the gut absorption of dietary calcium. Treatment and management options for chronic hypocalcemia vary depending on the underlying disorder. For example, in patients with hypoparathyroidism, calcium and vitamin D supplementation must be carefully titrated to avoid symptoms of hypocalcemia while keeping serum calcium in the low-normal range to minimize hypercalciuria, which can lead to renal dysfunction. Management of chronic hypocalcemia requires knowledge of the factors that influence the complex regulatory axes of calcium homeostasis in a given disorder. This chapter discusses common and rare disorders of hypocalcemia, symptoms and workup, and management options including replacement of PTH in hypoparathyroidism. (C) 2018 Elsevier Ltd. All rights reserved.