We have a 30 year old lady who apparently has been hypocalcaemic for the
last 10 years. Typically, her total calcium is 1.8 mmol/L, phosphate 1.2
mmol/L, albumin 42 g/L, magnesium 0.8 mmol/L. Her PTH is usually
low/low-normal, and the working diagnosis has been idiopathic
hypoparathyroidism. However, she has been unresponsive to vitamin D
treatment and has had several admissions for ‘fits’ which have been assumed
to be tetanic. Her total calcium has never adequately responded to calcium
or vitamin D supplements. Her urinary calciums have always been within our
reference interval. Her episodes of tetany also appear to have a functional
element to them.
Last week she had ionised calcium measured by a gas analyser and this was
found to be 1.52 mmol/L which would, if anything, suggest she is
hypercalcaemic. It now transpires that her mother has also been found to be
'hypocalcaemic' although she is asymptomatic.
Of course, the ionised calciums are going to be repeated, but I would be
grateful if anyone has any ideas on this case.
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