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Acute-onset hypomagnesemia-induced hypocalcemia caused by the refractoriness of bones and renal tubules to parathyroid hormone

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Abstract

Chronic hypomagnesemia is closely associated with hypocalcemia, which is caused by impaired parathyroid hormone (PTH) secretion or the refractoriness of bone and renal tubules to PTH. The dominant mechanism of acute-onset, hypomagnesemia-induced hypocalcemia is currently unclear. An 83-year-old man who had undergone chemotherapy with carboplatin for prostate cancer suffered from acute diarrhea and finger paresthesia. Laboratory data confirmed hypocalcemia as well as hypomagnesemia. Urinary calcium levels were not measured. However, the urinary fractional excretion of Mg (FEMg) was elevated. Despite elevated PTH levels, the renal tubular maximal reabsorption rate of phosphate to GFR (TmP/GFR) was elevated, and bone formation and resorption markers were suppressed. A magnesium loading test revealed a clear magnesium deficiency. After administration of magnesium, bone marker levels were increased, and TmP/GFR was reduced to normal levels, despite the persistent elevation of PTH. Serum calcium levels eventually increased to approximately the reference range. Clinical histories and these observations both suggest that when patients with hypomagnesemia-induced hypocalcemia rapidly lose magnesium through complications such as diarrhea, the primary cause may be the refractoriness of bone and renal tubules to PTH, rather than impaired PTH secretion.

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Conflict of interest

The authors have nothing to disclose. No potential conflicts of interest relevant to this article were reported. This report received no specific financial support from any funding agencies in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan

    Masahiro Yamamoto, Toru Yamaguchi, Mika Yamauchi, Shozo Yano & Toshitsugu Sugimoto

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  1. Masahiro Yamamoto
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  2. Toru Yamaguchi
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  3. Mika Yamauchi
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  4. Shozo Yano
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  5. Toshitsugu Sugimoto
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Correspondence to Masahiro Yamamoto.

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Yamamoto, M., Yamaguchi, T., Yamauchi, M. et al. Acute-onset hypomagnesemia-induced hypocalcemia caused by the refractoriness of bones and renal tubules to parathyroid hormone. J Bone Miner Metab 29, 752–755 (2011). https://doi.org/10.1007/s00774-011-0275-7

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  • DOI: https://doi.org/10.1007/s00774-011-0275-7

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