Total Serum Calcium Levels Research Articles

Total Serum Calcium Level Is Negatively Correlated With Systemic Lupus Erythematosus Activity.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease and hypocomplementemia signifies disease activity. Several studies have shown that calcium may help maintain optimum function of immune system and metabolism in SLE. The aim of our study was to analyze the relationship between total serum calcium level and SLE activity. A total of 66 patients with SLE and 214 healthy controls were included in this study. Our results showed lower serum levels of calcium (P < .001), complement C3 (P < .001), complement C4 (P < .001), and albumin (P < .001) in patients with SLE. A negative correlation was found between serum calcium level and systemic lupus erythematosus disease activity index (SLEDAI) rating (r = −0.394, P = .001). Additionally, serum level of calcium was positively correlated with serum complement C3 level (r = 0.366, P = .003) in patients with SLE, while no such correlation was found between serum calcium level and complement C4 (r = −0.190, P = .126). Likewise, patients with SLE with normal serum calcium level showed higher complement C3 level (P < .01) than that of patients with low serum calcium level. Overall, the results displayed that patients with SLE have lower serum calcium level compared to healthy controls, and the serum calcium level is positively correlated with SLEDAI rating and serum complement C3 level in patients with SLE. In conclusion, the total serum calcium level is negatively correlated with SLE disease activity.

EFFECT OF ANTIOXIDANT RICH DIETS ON SOME AUTISTIC CHILDREN IN EGYPT

This research was applied on two groups of autistic school children (6-10y). Group1 consumed experimental meals which had industrial products that containing preservatives snacks and cans in addition the experimental natural herbs and foods containing antioxidants. Group 2 consumed healthy diets containing antioxidants in natural herbs and foods according to the recommend dietary allowances supplemented and preventing all industrial foods containing preservatives snacks and cans for6 consecutive months. The experimental diets were analyzed that showed increase the content of the average intake of calories carbohydrate, fiber, protein, fat, cholesterol, vitamins and minerals compared with the ordinary diet consumed at the start of the experiment. Anthropometric results indicated that body weight and body mass index (BMI) of the autistic children in group1 was significantly increased in contrary to group 2 at the end compared to the corresponding values at the start the study. Serum total calcium level was increased significantly but iron, lead and catalase enzyme levels were significantly reduced in groups 1 while serum hemoglobin and mercury were significant reducedin group 2 at the end compared to the values of the start. Serum ferritin, HDL-c, vitamins (C&E) and glutathione peroxidase activity were significantly increased but serum copper concentration was decreased while serum total cholesterol, triglyceride, LDL-c ionized calcium level were in a non-significant reduction after consuming the experimental diets to the both groups (1&2) at the end compared with the mean values at the start of the study. It could be concluded that antioxidants as natural food and herbs improved the health status of autistic children under investigation. Key words: Autism children –antioxidant- healthy foods- herbs.

Correlation of Total Serum Calcium and Ionic Calcium Levels with Severity of Birth Asphyxia

Background: Birth asphyxia is a leading cause of morbidity and mortality among neonates in India.Common complications of birth asphyxia are cerebral palsy, persistent pulmonary hypertension of newborn,cardiogenic shock, irreversible renal cortical necrosis, hypotension, and heart failure. The risk of hypoxicischemicencephalopathy (HIE) increases with increasing severity of birth asphyxia. Hypocalcemia occurswith increased frequency in neonates with birth asphyxia. In our present study, we measured both ionized andtotal serum calcium levels in neonates with birth asphyxia and compared these levels with normal healthyneonates. Among cases, serum and ionic calcium levels were compared among neonates with differentstages of HIE to find co-relation of calcium levels with the severity of birth asphyxia.Method: Total serum calcium and ionic calcium levels obtained at birth were compared among neonateswith and without birth asphyxia. Among asphyxiated neonates, total and ionic calcium levels were comparedamong neonates with different staging of HIE.Results: Total serum calcium and ionic calcium levels at birth were significantly lower in cases (8.04 ± 0.89mg/dl, 3.62 ± 0.46 mg/dl) as compared to controls (9.32 ± 0.72 mg/dl, 4.79 ± 0.49 mg/dl). In the case grouplevel of Total serum calcium and ionic calcium levels showed a decreasing trend with increasing stage ofHIE. Level of total serum calcium and ionic calcium were 8.88±0.290, 4.03±0.178 mg/dl among babies whohad no HIE, 8.07±0.675,3.61±0.354 mg/dl among babies who had HIE-1, 7.78±0.572, 3.54 ±0.572 mg/dlamong babies who had HIE-2 and 7.03±0.596, 3.12±0.342 mg/dl among babies who had HIE-3.Conclusion: Total serum calcium and ionic calcium levels are decreased in birth asphyxia. Total serum andionic calcium levels are also decreased with increasing severity of HIE.

Evaluation of parathyroid function in adult male patients with transfusion dependent thalassemia

Background: In transfusion dependent thalassemic (TDT) patients regular blood transfusion leads to iron overload. This increased iron is deposited in the tissue of various system and causes organ damage. Endocrine dysfunction is very common due to iron deposition into the endocrine glands including parathyroid dysfunction.&#x0D; Objective: To measure plasma intact parathyroid hormone(iPTH), serum total calcium and inorganic phosphate levels in adult male patients with TDT.&#x0D; Methods:This cross sectional study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from March 2018 to February 2019. Total 35 TDT male patients aged 18 to 40 year and 35 age matched apparently healthy male subjects were enrolled for this study as control. The TDT patients were selected from the outpatient department of Hematology and Transfusion Medicine. For assessment of parathyroid function serum albumin, plasma iPTH, serum total calcium and inorganic phosphate levels were estimated by colorimetric method using automated analyzer. For statistical analysis, independent sample t test was done.&#x0D; Results: In this study, plasma iPTH and serum corrected calcium levels were significantly (p &lt; 0.001) lower in patients with TDT than those of healthy control. Again, Serum inorganic phosphate and ALP levels were significantly (p &lt; 0.001) higher in patients with TDT than those of healthy control. Moreover, 2.86% of TDT patients had low iPTH.&#x0D; Conclusion: From this study, it can be concluded that reduced parathyroid function was associated with TDT.&#x0D; J Bangladesh Soc Physiol. 2019, December; 14(2): 77-81

Prevalence of vitamin D deficiency and its relationship with epileptic severity in a pediatric department of tertiary care hospital

Aim To evaluate the prevalence of vitamin D deficiency in pediatric epileptic patients and to assess if there is any correlation between vitamin D level and disease severity in epileptic patients. Objective To estimate vitamin D deficiency and insufficiency as percentage of enrolled patients in pediatric department and to identify if there is any correlation between vitamin D deficiency and factors such as age, sex, BMI, total serum calcium levels, antiepileptic drugs, and types of seizures. Patients and methods A prospective interventional clinical study was carried out in a tertiary care hospital between September 2018 and February 2019. We included 30 pediatric epileptic patients of age group 1–14 years from whom the blood samples were withdrawn and were sent to the laboratory for the estimation of vitamin D levels. Results The data collected was analyzed using statistical method χ2 and analysis of variance in Prism 8.0 version. The prevalence of vitamin D deficiency and its correlation with epilepsy was determined. In this study, we found that there was a high prevalence of vitamin D deficiency in pediatric epileptic patients (23 patients out of 30–73%). The other risk factors for vitamin D deficiency found in this study are children of age group 5–10 years (43%), malnourished patients (40%), hypocalcemic patients (40%), and patients who use antiepileptic drugs for more than 2 years (57%). Conclusion Based on the aforementioned scientific analysis, it can be concluded that there is a high prevalence of vitamin D deficiency in pediatric patients with epilepsy. So, vitamin D3 supplements should be given for all epileptic children even before the initiation of antiepileptic therapy. Patients’ parents were educated on the importance of vitamin D.

ГИПОКАЛЬЦИЕМИЯ ПОСЛЕ ПАРАТИРЕОИДЭКТОМИИ

The aim of the study was to estimate the frequency and timing of hypocalcemia after surgical treatment for primary, secondary and tertiary hyperparathyroidism. Materials and methods. 21 patients were operated for hyperparathyroidism, 15 - for primary (group 1), 6 - for secondary and tertiary (group 2). In I group the median baseline level of total serum calcium was 3.06 mmol/l, phosphorus0.9 mmol/l, and parathyroid hormone360 pmol/l. In II group all patients were on program dialysis for end-stage chronic kidney failure for at least five years. The median baseline serum total calcium level was 2.29 mmol/l, phosphorus2.64 mmol/l, and parathyroid hormone-1822 pmol/l. Results. A day after removal of the parathyroid adenoma (1 group) the level of calcium and phosphorus was normalized, the content of parathyroid hormone (median 21.4 pmol/l) significantly decreased. In one case (6.7%) on the fifth day there were clinical signs of hypocalcemia and the level of calcium decreased to 1.86 mmol/l. All patients of the second group underwent subtotal parathyroidectomy. After a day the level of parathyroid hormone significantly decreased (median227 pmol/l). The phosphorus content has returned to normal. The calcium level in all cases exceeded 2 mmol/l. On day 4-5 the total calcium content decreased and ranged from 1.14 mmol/l to 2.04 mmol/l. Four patients (66,7%) showed clinical signs of hypocalcemia. It was found that the development of hypocalcemia has a positive correlation of average value with the level of parathyroid hormone, phosphorus and negative with the content of calcium before surgery. Conclusion. The decrease in the level of total calcium with the development of clinical symptoms occurs on 4-5 days after surgery for primary hyperparathyroidism in 6.7% and for secondary or tertiary - in 66.7%. Risk factors for hypocalcemia are the baseline low level of calcium and high of parathyroid hormone, phosphorus.

Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India

Background:Calcium requirement increases during pregnancy, thereby increasing the chances of developing hypocalcaemia. Hypocalcaemia may be associated with pregnancy-related complications. Therefore, we planned this study to estimate the prevalence of hypocalcaemia among pregnant women attending secondary care hospital, and to study the association between hypocalcaemia and pregnancy outcomes.Materials and Methods:This study was conducted in a secondary level hospital at Ballabgarh, district Faridabad, Haryana, India. Consecutive pregnant women with gestation period more than 28 weeks were enrolled. Dietary calcium intake was ascertained using 24-hour dietary recall method. Serum calcium estimation was done by Biolis 24i auto analyser. Outcome of pregnancy (preterm delivery, low birth weight (LBW) babies, and neonatal mortality) was assessed telephonically 3 months after the enrolment.Results:A total of 696 pregnant women were enrolled in the study. Mean (SD) dietary calcium intake and serum calcium level was 796.4 (360.4) mg/day and 9.56 (0.94) mg/dl respectively. Prevalence (95% CI) of hypocalcaemia was 23.9% (20.8 – 27.2%). Serum total calcium level was not associated with dietary calcium intake (p-value = 0.36). Mean serum calcium level was significantly lower in mothers who had LBW babies. Pre-eclampsia, preterm delivery, and neonatal mortality were not associated with serum calcium level.Conclusion:Serum calcium level may not be related to dietary calcium level. Hence, the current recommendation of calcium supplementation during antenatal period appears to be inconclusive among our study population.

Fetal Hemoglobin, Serum Total Cholesterol, Plasma Phosphate and Serum Calcium Levels in Patients with Leukemia and Lymphoma

In this study, fetal hemoglobin (HbF), blood total cholesterol, phosphate and calcium levels of leukemia and lymphoma cases in Mandalay were determined. It was a cross-sectional, comparative study. Thirty adult cases of leukemia and lymphoma and equal number of control subjects of comparable age (14 to 80 yrs) and sex were studied. Mean HbF of leukemia group (n=9), acute myeloid leukemia (AML) subgroup (n=6) and controls (n=30) were 2.72±0.47%, 3.17±0.69% and 1.39±0.25% of total Hb, respectively. The HbF levels of leukemia group and AML were significantly higher than that of controls (p&lt;0.02). Mean serum total cholesterol levels of leukemia group, AML subgroup and controls were found to be 126.5±17.38 mg%, 137.96±24.66 mg% and 177.18±7.68 mg%, respectively. Cholesterol levels of leukemia group and AML were lower than that of controls. Mean plasma phosphate levels of leukemia and lymphoma cases (n=30), leukemia group (n=9) and lymphoma group (n=21) were 1.21±0.07 mmol/l, 1.33±0.17 mmol/l and 1.15±0.06 mmol/l, respectively. Mean phosphate level of controls was 0.94 mmol/l. Plasma phosphate levels of the whole cases and individual case groups were significantly higher than that of controls (p&lt;0.001). Mean serum calcium levels of the whole cases, leukemia group and lymphoma group were 10.16±0.36 mg%, 10.03±0.75 mg% and 10.21±0.45 mg%, respectively. Mean serum calcium level of controls was 8.55±0.14 mg%. Serum calcium levels of the whole cases and individual case groups were found to be significantly higher than that of controls (p&lt;0.01). The study showed that not only raised HbF but also hypocholesterolaemia might be the diagnostic clues in leukemia cases. Recognition of blood phosphate and calcium changes leads to appropriate therapy and a reduction of morbidity.

4-Hour postoperative PTH level predicts hypocalcemia after thyroidectomy in children

BackgroundHypocalcemia occurs frequently after a total thyroidectomy in pediatric patients. Four hour postoperative PTH monitoring predicts the need for calcium supplementation in the adult thyroidectomy population. We evaluated the role of the 4 h postoperative PTH level in determining the need for calcium supplementation after thyroidectomy in the pediatric population. MethodsThis is a retrospective review of children undergoing total thyroidectomy by a single pediatric surgeon from July 2011 through July 2018. Intact PTH obtained four hours postoperatively determined the need for calcium supplementation for patients beginning in November 2014 onward. Serum total calcium levels were monitored concurrently with serum intact PTH levels. Serum calcium levels were followed in our Multispecialty Pediatric Endocrine Surgery clinic within the month following thyroidectomy. ResultsFrom July 2011 through July 2018, there were a total of 56 total thyroidectomies at our institution. Prior to November 2014, all pediatric total thyroidectomies received calcium supplementation per our institutional protocol. Based on ionized calcium levels, 26.3% (5/19) of children developed hypocalcemia. From November 2014 to July 2018, 37 pediatric patients required total thyroidectomies. 29.7% (11/37) had low 4-h postoperative PTH levels. 72.7% (8/11) patients with low 4-h postoperative PTH levels had corresponding postoperative day 1 total calcium levels less than 8.5 or ionized calcium levels less than 1.12, and five children (45.5%) developed symptomatic hypocalcemia. 70% (26/37) of children had normal 4-h postop PTH levels, with only 5 (19%) ever developing hypocalcemia. No patients with a normal postop PTH level developed symptomatic hypocalcemia or required IV calcium repletion. A single 4-h postoperative PTH <10 pg/dl for identifying hypocalcemia has a sensitivity of 81% and specificity of 91%, with AUC 0.81. ConclusionThe 4-h postoperative serum PTH level can help determine the need for calcium supplementation in pediatric patients undergoing total thyroidectomy, thereby reducing unnecessary calcium supplementation and serial lab draws to monitor for postoperative hypocalcemia. Level of evidenceLevel II.

Patients with primary hyperparathyroidism undergoing surgical intervention in two tertiary care hospitals in Sri Lanka

Introduction Autonomous production of parathyroid hormone results in primary hyperparathyroidism. Sri Lankan studies analyzing cases of hyperparathyroidism are scarce. Objective To describe clinical, biochemical, radiological and pathological characteristics of patients with primary hyperparathyroidism undergoing surgical intervention in two tertiary care hospitals in Sri Lanka. Design Data was collected from the available records of all patients who has undergone surgery for primary hyperparathyroidism at Teaching Hospital, Kandy and General Hospital, Badulla from 2016.10.27 to date. A total of ten patients with primary hyperparathyroidism were enrolled for analysis. Out of the ten patients, six were females. Ages ranged from 23 to 65 years (Mean- 44.2). Mode of presentation was fragility fractures in four patients, renal calculi in five patients and acute pancreatitis in one patient. Bone complications (fractures, osteoporosis) were seen in four patients and renal complications (renal calculi, nephrocalcinosis) were seen in six patients. Pre-operative total serum calcium levels ranged from 10.52 to 14.16 mg/dl (mean-12.6). Pre-operative serum phosphate levels ranged from 0.74 to 1.07 mmol/L (mean -0.868). X-ray evidence of skeletal changes of hands were seen in 6 patients (60%), of which 4 showed bony deformities and 2 showed pathological fractures. Renal calculi or nephrocalcinosis was detected by X-ray in five out of six patients and ultrasonically in all 6 patients. Ultrasound scans revealed a parathyroid adenoma in 8 patients (80%), while 2 were negative. Technetium-99-methoxyisonitrile (99m Tc-Sestamibi) scans were performed in 4 patients and three had positive images. Histological analysis revealed 8 patients with single parathyroid adenoma, 1 with parathyroid carcinoma, and one patient with four gland hyperplasia. Discussion and Conclusions All patients had symptoms at the time of diagnosis. Ultrasound scan was a useful tool for the localization.

A Study of Vitamin D and Calcium Level in Beta Thalassemia Major in Duhok Province

β-thalassemia major is severe hemolytic anemia which requires repeated blood transfusion and for survival, which leading to iron overload. Serious complications due to iron over load are recognized in the thalassemia patients. objectives Vitamin D and calcium are important factors for homeostasis of calcium in this study. This study was conducted for a period of two year including from patients with β- thalassemia major from Duhok Thalassemia Centre between 2014 -2015. Thirty eighth β- thalassemia major patients and thirty eighth persons with age- matched as control group were enrolled in the study. Serum concentration of 25- hydroxy vitamin D and calcium were estimated by enzyme linked fluorescent assay and colorimetric method, respectively. In patients, the level of serum 25- hydroxy vitamin D was significantly lower 11.11±4.36 ng/mL compared with control group (14.03±5.96ng/mL). Vitamin D deficiency is observed about 94.73% in patients. The mean level of serum calcium in patients group is 7.9±0.47mg/dL and 8.98±0.77 mg/dL in control group. There was a statistically significant difference in serum calcium value between patients and control group. 44.73% of patients have hypocalcaemia. This study demonstrated a high prevalence of Vitamin D deficiency and low total serum calcium levels in thalassemia patients with a significantly lower than healthy group. Hypocalcemia and vitamin D deficiency may be results from the negative effect of the repeated blood transfusion and malnourishment.

Bone Mineral Metabolism Status, Quality of Life, and Muscle Strength in Older People.

As the relationship between vitamin D and various diseases or health conditions has become known, interest in the contribution of vitamin D to overall health-related quality of life (QoL) has increased. We examined the relationship between vitamin D status and QoL in 273 participants aged 65 years and older. Serum levels of total calcium, phosphorus, intact parathyroid hormone, albumin, and 25-hydroxyvitaminD3 were analyzed. We also recruited data for QoL, physical activity, nutritional impairment, and muscular strength. Ninety percent of the subjects were classified as vitamin D deficient or insufficient. Participants with higher serum 25(OH)D3, calcium, phosphorous, and Alb levels were significantly less likely to self-report depression or anxiety after adjustment (p = 0.009, p = 0.005, p = 0.003, and p = 0.005, respectively). Additionally, we found an association between lower levels of albumin and self-reported problems with mobility or usual activities (p = 0.01). We also found associations between better muscle strength and higher levels of vitamin D, calcium, phosphorous, and albumin (p = 0.006, p = 0.003, p = 0.004 and p = 0.002, respectively). Overall, our data provide evidence that serum vitamin D and Alb levels are negatively related to self-reported anxiety or depression, usual activities, mobility, and three dimensions of QoL in older adults. Furthermore, vitamin D levels are positively related to hand grip strength in adults over 65 years old.

Clinico-epidemiological study of neonatal seizures from a tertiary care hospital of Western Rajasthan, India

Background: Neonatal Seizures are frequent may be either symptoms of an underlying disorder and malfunction of the developing CNS or due to a primary epileptic condition. Their varied clinical presentations, delay in recognition and treatment results in poor neurological outcome. This study attempts to find out the clinical and etiologic profile of neonatal seizures and associated biochemical abnormalities in this geographical part of India.Methods: A hospital based prospective observational study undertaken in a tertiary care pediatric hospital of Medical College Jodhpur India, on 202 consecutive neonates who presented with seizures during period of one year. A detailed antenatal history and baseline characteristics of convulsing neonate at admission and clinical details of each seizure episode reported by the mother and subsequently observed by doctors on duty were recorded. Venous blood sample was analyzed as soon as possible for blood glucose, total serum calcium levels and electrolytes, before instituting any treatment. Data were managed on Microsoft Excel spreadsheet, and analysis was performed using SPSS version.Results: The overall frequency of neonatal seizures in our set up was recorded as 4.08%. Perinatal asphyxia with subsequent HIE was the most common (40.09%) cause of neonatal seizures while hypoglycemia was the most common metabolic cause (11.38%) observed specially in VLBW babies. Subtle seizures were the most common type (34.65%) and tonic seizures were the second most common (33.66%) type of seizures encountered. Hypocalcemia was the second commonest biochemical abnormality found in primary metabolic seizures. HIE, ICH and Hypoglycemia were the common seizure etiology in preterm neonates.Conclusions: Perinatal asphyxia and subsequent HIE was the commonest etiology with subtle, tonic and multifocal seizures being the commonest clinical types encountered. Hypoglycemia and hypocalcemia were the most frequent biochemical abnormality found.

Derivation of a cost-saving screening strategy for asymptomatic primary hyperparathyroidism

BackgroundOur study seeks to find a cost-saving screening strategy in a primary care population for diagnosing primary hyperparathyroidism based on peak serum total calcium level, age, and patient sex. MethodsLaboratory data resulting from primary care office visits at our institution between January 2016 through December 2017 to evaluate patients who had at least 1 episode of hypercalcemia (≥10.5 mg/dL). For each serum calcium threshold, we calculated the percentage of patients who were found to have an increased parathyroid hormone level (≥65 pg/mL). We determined whether net cost savings could be achieved by screening hypercalcemic patients given their probability of primary hyperparathyroidism and expected cost savings from fracture risk reduction, given their sex and age. ResultsFrom 155,350 unique patients in the study period, a total of 2,271 had a minimum of 1 hypercalcemic lab value. After exclusion criteria, there were 1,326 patients of whom 27.5% had a parathyroid hormone level checked. Cost savings was established at a screening threshold of 10.5 for all patients until age 66 years for men and 69 years for women. For men aged 67–68 y and women aged 70–71 years, the optimal screening threshold was 10.8 mg/dl. ConclusionCost savings can be achieved by screening hypercalcemic patients with a life expectancy exceeding 16 years, with varying thresholds based on age and sex.

Long-term effects on PTH and mineral metabolism of 1.25 versus 1.75\u2009mmol/L dialysate calcium in peritoneal dialysis patients: a meta-analysis

BackgroundThis study aimed to compare 1.25 and 1.75 mmol/L dialysate calcium for their effects on parathyroid hormone (PTH) and mineral metabolism in peritoneal dialysis (PD).MethodsThe PubMed, Cochrane Library, and EmBase databases were searched from inception to October 2016. Methodological quality assessment of the included studies was performed using the risk of bias tool of the Review Manager software. The meta-analysis was carried out with the Stata12.0 software. Subgroup analysis was performed by study design [randomized controlled trial (RCT) and non-RCT]. Odds ratios or standardized mean differences were used to assess the outcome measures, including intact parathyroid hormone (i-PTH) levels, serum total calcium amounts, ionized calcium levels, phosphate concentrations, and peritonitis episodes.ResultsSeven studies were enrolled in the synthesized analysis, including 4 RCTs and 3 non-RCTs. All studies compared 1.25 mmol/L and 1.75 mmol/L dialysate calcium for PD. Pooled analysis revealed that 1.75 mmol/L dialysate calcium significantly reduced i-PTH levels compared with the 1.25 mmol/L dose in PD patients. However, 1.25 mmol/L dialysate calcium was superior to the 1.75 mmol/L dose in decreasing the levels of serum total calcium and ionized calcium in PD patients. No significant differences in phosphate amounts and peritonitis episodes were observed between the two groups.ConclusionThese findings indicated that 1.75 mmol/L dialysate calcium is more appropriate for PD patients with secondary hyperparathyroidism. Meanwhile, 1.25 mmol/L dialysate calcium is more favorable to PD patients with secondary hypercalcemia. However, further well-designed and high-quality studies are required to validate these findings.

Serum proteinogram and biochemistry of Holstein cows in the peripartum period

ABSTRACT: In face of the few reports found in national literature analyzing the potential influence of parturition number in serum proteinogram and biochemical profile in the peripartum period of high yielding dairy cows, the aim of the present study was to comparatively evaluate the dynamics of these serum constituents’ concentrations in blood samples obtained from primiparous and multiparous Holstein cows, 60 and 30 days prepartum and in the day of parturition. Data were analyzed by repeated measures variance analysis (ANOVA) and differences between groups and moments were analyzed by Tukey’s test. Results were considered significant when P&lt;0.05. Parity influenced levels of total protein, albumin, globulins, magnesium, cholesterol, which were higher in multiparous cows, as well as concentrations of ceruloplasmin, total calcium, chloride and alkaline phosphatase activity, which were higher in primiparous cows. Parturition influenced serum concentrations of ceruloplasmin (+58%), transferrin (-25%), haptoglobin (+33%), total protein (-17%), globulins (-25%), immunoglobulin A (-43%), immunoglobulin G (-24%), total calcium (-12%), inorganic phosphorus (-10%), chloride (+5%), sodium (+4%), cholesterol (-23%), triglycerides (-38.6%), as well as activities of aspartate aminotransferase (+14%) and alkaline phosphatase (+28%). A decrease in serum levels of total calcium, inorganic phosphorus, cholesterol and triglycerides was more pronounced in multiparous than in primiparous cows. These results demonstrate that the interpretation of proteinogram and serum constituents should take into consideration lactation number and the moment of parturition as relevant factors in high yielding dairy cows in the transition period.

SUN-053 Gender Disparity In Association Between Serum Total Calcium And Blood Pressure In A Normocalcemic High Salt Diet Population.

Calcium metabolism has been shown to be associated with blood pressure, however, the results from gender subgroup analysis is conflicting. Some studies have shown strong correlation in women while other studies have shown weaker associations in women. Hence, the purpose of this epidemiology study is to evaluate the association of serum total calcium levels with blood pressure based on gender. This is a secondary analysis of epidemiology data from the Northeast China Rural Cardiovascular Health Study conducted 2012-2013. Resting blood pressure was measured 3 times in each participant using a standardized electric sphygmomanometer after sitting for 5 min. Men and non-pregnant women ≥18 years old, normocalcemic (2.25-2.58 mmol/L) [Diagnostics, 9th ed. People's Medical Publishing, China], and no prior history of hypertension or anti-hypertension medication were included. Serum calcium levels were stratified into quartiles (i.e., Q1: 2.25-2.33 mmol/L, Q2: 2.33-2.41, Q3: 2.41-2.50, Q4: 2.50-2.58 mmol/L), and hypertension was defined as mean systolic BP ≥140mmHg and/or mean diastolic BP ≥90mmHg. This study population has been previously shown to have high salt intake (9.7 g/d) [Li et al. J Am Soc Hypertens 9:358]. A total of 6550 normocalcemic participants met the inclusion criteria, of whom 51% were women and 39% were hypertensive. The mean serum calcium level was slightly higher in men than in women (2.38 ± 0.08 vs. 2.37 ±0.08; p=0.007) More men were hypertensive than women (42.6% vs. 35.1%; p<0.001). In the serum calcium quartiles, 34% (805/2401) normocalcemic participants in the lowest quartile Q1 were hypertensive, 38% (777/2037) in Q2, 44% (649/1470) in Q3, and 48% (310/642) in Q4. For men, the odds of hypertension increases as serum calcium quartile increases: the odds of hypertension in Q3 is 39% (95% CI, 1.151-1.673) higher compared to Q1, and in Q4 is 67% (95% CI, 1.321-2.160) higher. Similarly, in non-pregnant women, the odds of hypertension increases through the quartiles when compared to Q1: Q2 is 31% (95% CI, 1.095-1.556) higher, Q3 is 75% (1.448-2.121) higher, and Q4 is 99% (95% CI, 1.545-2.573) higher. Even though the odds of hypertension were consistently higher in women than in men in all serum calcium quartiles, there was no statistical difference in the odds ratio. In linear regression, the serum calcium level is a stronger predictor of systolic BP in women than in men (0.175 vs. 0.110; p=0.008), however the association with diastolic BP tends to be stronger in men than in women (0.070 vs. 0.063; p=0.74). In conclusion, in normocalcemic participants without a history of hypertension, the odds of having high blood pressure increases as serum calcium levels increases even within the normal range. In this high salt diet population, women trends to having higher odds of hypertension with a stronger association of systolic BP to serum total calcium levels.

MON-257 A Case of Primary Hyperparathyroidism Complicated by Vitamin D Deficiency

Background: Primary hyperparathyroidism is a relatively common disorder caused by the inappropriate autonomous secretion of parathyroid hormone which subsequently leads to hypercalcemia. There is increased prevalence of vitamin D deficiency in patients with primary hyperparathyroidism. As these patients are already hypercalcemic, there is reluctance within the medical community to provide vitamin D supplementation due to fear of exacerbating hypercalcemia. Clinical Case: A 17 year old African American male was referred to the pediatric endocrinology clinic for hypercalcemia (total serum calcium level 11.2 mg/dL, 8.6-10.6). His past medical history was significant for a diagnosis of membranoproliferative glomerulonephritis type 2 which was in remission. His most recent blood tests showed normal renal function. A review of his hospital chart showed that his calcium levels had been on the upper end of the reference range or above it for at least a year prior to his presentation to the clinic. He had no signs or symptoms concerning for hypercalcemia. He was not taking any calcium supplements or other medications which are known to be associated with elevated calcium levels. There was no known family history of hypercalcemia. He denied any history of renal stones, adrenal disease, weight loss, or osteoporosis but did report a wrist and knee fracture both of which occurred during competitive wrestling matches. His vital signs and physical exam were unremarkable. On laboratory analysis his serum calcium was 11.0 mg/dL, intact PTH 112 pg/mL (ref range 12-88), 25 hydroxyvitamin D was 10 ng/mL (ref range 20-80), Alk Phos 145 U/L (ref range 100-300), Albumin 4.8 g/dL (3.4-5.0), TSH 1.97 mcIU/mL (0.35-4.0), Free T4 0.8 ng/dL (0.6-1.7), Cr 0.94 mg/dL (0.5-1.3), 24 hour urine calcium excretion was 228 mg and calculated calcium to creatinine ratio was 0.07. Ultrasound of the neck and nuclear parathyroid scan and did not definitively show a parathyroid adenoma but could also not rule out the presence of an adenoma. Given patient’s low 25 OH vitamin D level he was given a 4 week course of supplemental vitamin D (1,000 units daily) with resultant 25 OH vitamin D level of 21 ng/mL. His serum calcium and intact PTH level remained elevated at 10.9 mg/dL and 108 pg/mL respectively. The patient was sent to otolaryngology for evaluation should the need arise in the future for surgical intervention and genetic testing to definitively rule out familial hypocalciuric hypercalcemia was sent. As he is asymptomatic with mild hypercalcemia currently, we will continue to monitor yearly per guideline recommendations. Conclusion: Supplementation with modest doses of vitamin D did not significantly raise our patient’s calcium level and led to an improvement in the 25 hydroxyvitamin D level. Vitamin D repletion should be considered in cases of asymptomatic primary hyperparathyroidism associated with mild hypercalcemia.

SUN-521 Intracranial Calcifications Outside the Basal Ganglia at Presentation of Barakat Syndrome

Hypoparathyroidism-sensorineural Deafness-Renal dysgenesis (HDR, or Barakat) syndrome is an uncommon cause of hypoparathyroidism, representing fewer than 200 documented cases in the literature worldwide. Individuals with HDR have variable penetrance and a range of phenotypes. While basal ganglia calcifications are known to occur with chronic hypoparathyroidism, they are less common in children and intracranial calcifications outside the basal ganglia, to our knowledge, have not been documented in HDR syndrome. Case presentation: A 10 year-old boy with a history of sensorineural deafness and attention deficit hyperactivity disorder presented after a new-onset seizure during a basketball game. His initial total serum calcium level of 5.9 mg/dl with an albumin level of 4.4 mg/dl, serum phosphorus was 7.0 mg/dl, and normal creatinine for age. PTH level was 2 pg/ml. He was started on calcitriol and calcium supplementation. There was no prior personal nor family history of hypocalcemia, nephrolithiasis, deafness nor renal problems. A head CT showed calcifications in the basal ganglia as well as at the temporal and frontoparietal gray-white matter junction and thalamus. Parathyroid antibody testing was negative. Subsequent genetic analysis of the GATA3 gene indicated heterozygosity for c.790T>C causing a missense mutation (p.Cys264Arg), that has been reported to cause HDR due to altered DNA binding affinity of the zinc finger component of GATA3. On renal ultrasound kidneys were in the 8th-13th percentile for size, raising the possibility of mild hypoplasia. Post-treatment urine Calcium-to-Creatinine ratio was 0.105. We describe a case of HDR in childhood who presented with seizures and very rare pediatric finding of calcifications in the basal ganglia as well as additional intracranial calcification in the thalamus and temporal and frontoparietal gray-white matter junction, which to our knowledge have not previously been described with HDR Syndrome. This case highlights important features of this disorder including severe intracranial calcifications and morphologic renal anomalies. HDR patients are at high risk for renal impairment, which is a key prognostic factor. Thus, careful monitoring of renal function, avoidance of nephrotoxins and of excessive calciuria during hypoparathyroidism management are necessary.

MON-541 Successful Treatment of Normocalcemic Hyperparathyroidism in Children

Childhood and adolescence are the critical periods for the establishment of lifelong bone health. Normocalcemic primary hyperparathyroidism (NPHPT) has been recognized as a variant of primary hyperparathyroidism (PHPT) 15 years ago and it is characterized by elevated PTH level with persistently normal concentrations of albumin-adjusted total and ionized calcium, in the absence of secondary causes of hyperparathyroidism and it is related to increased risk in development of osteopenia or osteoporosis as well as development of parathyroid adenoma and hypercalcemia-hypercalciuria with renal consequences. In order to identify biochemical disorders of PTH in normocalcemic children we performed in all patients that visited our pediatric endocrine unit for two years (1-Nov 2016 until 31-Oct 2018), a complete calcium metabolism evaluation (Ca, P, ALP, 25OHD, intact PTH). A total of 3060 patients - excluding those that consulted for vitamin D deficiency, Ca metabolism abnormalities or known renal pathology (i.e. Bartter syndrome) - were included. We identified 157 patients (5.1%) with hyperparathyroidism (PTH > 45 pg/ml, Horm Res Paediatr 2015;84:124-129) and normal total serum calcium levels; adequate data on laboratory results and follow up were available in 114 patients; 67 (58.7%) of them were vitamin D replete (25OHVitD >30 ng/ml, group 1) and forty-seven were vitamin D deficient (41.3 %) (25OHVitD <30 ng/ml, group 2). All patients were treated with cholecalciferol (8000-16000 IU daily). All patients in groups 1 and 2 who did not normalize their PTH (< 45 pg/ml) within 6 months of monotherapy with vitamin D, received additional calcium supplementation (1000 mg/day). Evaluation of calcium metabolism (Ca, P, ALP, 25OHD, 1,25OHD, PTH) was performed every 3 months. In 6 patients (4 from group 1 and 2 from group 2) elevated PTH did not respond to 6 months of combined cholecalciferol/calcium therapy. These patients were switched to the non-calcemic synthetic 1-25(OH)2-vitamin D analogue, paricalcitol, at the dose of 2 mcg x 1-3/day. Evaluation of calcium metabolism (Ca, P, ALP, 25OHD, 1,25OHD, PTH, urine Ca/Cr) was performed every 3 months. Parathormone levels normalized in 5 patients by 3 months of treatment and in one by 10 months of treatment with calcium in serum and urine being within normal range for age during treatment in all patients. We propose that all normocalcemic children that are checked for vitamin D deficiency undergo concomitant measurement of PTH levels. Subclinical hyperparathyroidism (PTH > 45 pg/ml) should be treated with cholecalciferol (8000-16000 IU/day) and calcium supplementation (1000 mg/day) and if unresponsive after a minimum of 3 months, with paricalcitol 2-6 mcg/day in order to normalize PTH and protect their bone and general health. Further studies are needed to standardize this approach.