Bilateral hypocalcemic cataract after total thyroidectomy in a young woman: case report

Pharmacokinetics, Pharmacodynamics, and Safety of Evocalcet (KHK7580), a Novel Calcimimetic Agent: An Open-Label, Single- and Multiple-Dose, Phase I Trial in Healthy Chinese Subjects

Purpose

This study explored the pharmacokinetics (PK), pharmacodynamics (PD), and safety of evocalcet (KHK7580), a new calcimimetic agent, in healthy Chinese subjects following single and multiple doses.

Methods

This was a single-center, open-label phase I trial conducted in China. The study started from the single-dose cohorts (1, 3, 6, 12 mg evocalcet, step-by-step administration) and proceeded to the multiple-dose cohort (6 mg evocalcet once daily for eight days). Blood and urine samples were collected at the designated time points for pharmacokinetic and pharmacodynamic analysis. Safety was evaluated by treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, electrocardiograms (ECGs), and ophthalmological examination.

Results

Among 42 enrolled subjects, eight in each single-dose cohort and 10 in multiple-dose cohort, 40 subjects completed the study. In single-dose cohorts, tmax was 1.00-2.00 h and declined biphasically. The mean t1/2 was 15.99-20.84 h. Evocalcet exposure in AUC0-inf, AUC0-t, and Cmax showed a dose-proportional increase. In the multiple-dose cohort, tmax was 2.00 h and declined biphasically after multiple administrations. The accumulation was negligible. Ctrough levels were similar across days and steady from 24 hours after the first administration. The mean t1/2 was 15.59 h. PD analysis showed that evocalcet decreased intact parathyroid hormone and corrected calcium levels in a dose-dependent manner. Seventeen (40.5%) subjects reported TEAEs. No serious or severe TEAE occurred.

Conclusion

In healthy Chinese subjects, evocalcet demonstrated dose-dependent PK and PD properties and was well-tolerated.

Impact of clinico-biochemical variations on the etiopathogenesis of cataract: a case-control study

Purpose:

Cataract is a major cause of blindness worldwide with a greater prevalence in developing countries like India. Owing to speculations about the relationship of various biochemical markers and cataract formation this case-control study was designed with the aim to know the impact of serum blood sugar, serum electrolytes and serum calcium on the etiopathogenesis of cataract in Kashmiri population.

Methods:

A total of 300 cases diagnosed with cataract and 360 healthy controls were taken for the study. Serum of all the cases and controls was analyzed for blood sugar and calcium using spectrometric techniques. Sodium and potassium were analyzed using Ion-Selective Electrode technology. All the investigations were done on ABBOTT c4000 fully automatic clinical chemistry analyzer.

Results:

Most of the patients in our study were ≥50 years of age having posterior subcapsular cataract. The mean levels of serum fasting blood sugar (mg/dL), serum sodium (mmol/L), serum potassium (mmol/L) and serum calcium (mg/dL) were 99.4 ± 7.7; 140.4 ± 2.5; 4.2 ± 0.5; and 8.9 ± 0.5, respectively, in cases compared to 107.7 ± 12.3; 142.9 ± 5.0; 3.8 ± 0.5; and 8.3 ± 1.7, respectively, in healthy controls. A significantly higher number of cataract cases had elevated serum glucose and sodium levels, low serum potassium and calcium levels compared to healthy controls.

Conclusions:

Hyperglycemia, hypernatremia, hypokalemia and hypocalcemia can independently increase the patients’ risk to cataracts. Corrections in these biochemical parameters may reduce cataract incidence.

Bilateral hypocalcaemic cataracts due to idiopathic parathyroid insufficiency: A case report

BACKGROUND

Hypoparathyroidism is uncommon, and cataracts secondary to hypoparathyroidism are even rarer. Herein, we report a case of bilateral cataracts following hypoparathyroidism.

CASE SUMMARY

A 27-year-old man presented to our hospital because of painless and progressive visual impairment of both eyes over two years. He was previously diagnosed with hypocalcemia but did not take calcium supplements regularly. He had no history of anterior neck thyroid surgery. After admission, the biochemical analysis indicated a serum calcium level of 1.21 mmol/L and an intact parathyroid hormone level of 0 pg/mL. Ocular examination revealed bilateral symmetrical opacity of the lens presenting as punctate opacity in the posterior subcapsular cortex together with radial opacity in the peripheral cortex (N1C2P3). Phacoemulsification with an intraocular lens was performed in both eyes sequentially. Postoperatively, the patient had a satisfactory recovery and greatly improved visual acuity.

CONCLUSION

This patient had hypocalcemia owing to idiopathic parathyroid insufficiency. Hypoparathyroidism may go unnoticed for years but with some latent clinical manifestations, such as bilateral symmetrical posterior subcapsular cataracts. This case report highlights that the cause of hypocalcemia in particularly young patients should be further investigated. Clinicians should be aware of hypoparathyroidism as a cause of bilateral cataracts. Early identification of hypoparathyroidism can save patients from further complications.

Erworbene Katarakte

Weitaus seltener und daher weniger bekannt als die altersbedingte Katarakt ist die sekundär erworbene Katarakt, die eine diagnostische und chirurgische Herausforderung darstellen kann. Dieser Beitrag gibt einen Überblick über die häufigsten Subtypen vor allem bei Erwachsenen und beleuchtet die chirurgischen Besonderheiten einschließlich perioperativer Charakteristika.

Erworbene Katarakte

Weitaus seltener und daher weniger bekannt als die altersbedingte Katarakt ist die sekundär erworbene Katarakt, die eine diagnostische und chirurgische Herausforderung darstellen kann. Dieser Beitrag gibt einen Überblick über die häufigsten Subtypen vor allem bei Erwachsenen und beleuchtet die chirurgischen Besonderheiten einschließlich perioperativer Charakteristika.

Quantitative investigation of the effect of surgically induced hypoparathyroidism on cataract development

INTRODUCTION

Although cataract formation is known in hypoparathyroidism, lens clarity and its correlation with clinical parameters have not been investigated quantitatively before in patients with hypoparathyroidism. The aim of this study was to compare the crystalline lens clarity of patients with surgically induced hypoparathyroidism and healthy subjects.

MATERIALS AND METHODS

Forty female patients with surgically induced hypoparathyroidism and 38 age-matched healthy female subjects were enrolled in this study. Scheimpflug corneal topography was performed to measure lens density (LD) and thickness (LT). Serum calcium, inorganic phosphorus, parathyroid hormone (PTH) levels, and disease duration were recorded.

RESULTS

No statistically significant difference was observed between the hypoparathyroidism and control groups in the Pentacam densitometry zones 1-2-3, LT, and average and maximum LD (p > 0.05 for all). Nine blue-dot-like, two cortical, and two posterior subcapsular cataracts were detected in the hypoparathyroidism group. The frequency of total and blue-dot-like cataracts was significantly higher in the hypoparathyroidism group than in the control group (p = 0.008 and p = 0.002, respectively). In the hypoparathyroidism group, a significant correlation was observed between the maximum LD and the hypoparathyroidism duration (ß = 0.420, p = 0.017), and the maximum LD and serum PTH level (ß = -0.332, p = 0.049).

CONCLUSION

The clarity of the crystalline lens may decrease in surgically induced hypoparathyroidism patients depending on the disease duration and PTH levels. Additionally, this study detected an increased frequency of blue-dot-like cataract in the patient group, which may be due to the effect of hypoparathyroidism.

Reversible congestive heart failure associated with hypocalcemia: A case report

BACKGROUND

Hypoparathyroidism is a rare disease that may occur due to primary or secondary etiologies. The estimated incidence in the United States is 24–37/100000 person-years. Congestive heart failure associated with hypocalcemia due to hypoparathyroidism is an even rarer presentation.

CASE SUMMARY

Here, we present a 64-year-old woman with congestive heart failure following hypocalcemia. The patient was transferred to our emergency department with complaints of rapidly progressive dyspnea, shortness of breath and heaviness of the chest for 4 d. She had a history of undergoing thyroidectomy and partial tracheotomy 2 years prior due to a malignant thyroid tumor. Muscle spasms had been present 1 year ago, and cataracts were treated with intraocular lens replacement in both eyes. Most tests were within normal ranges, except serum calcium at 1.33 mmol/L (2.20–2.65 mmol/L), ionized calcium at 0.69 mmol/L (1.15–1.29 mmol/L), and parathyroid hormone at < 1.0 pg/mL (12–88 pg/mL). Echocardiography revealed an ejection fraction of 28.48%. Cardiac function was quickly reversed by restoring the serum calcium concentration. Significant improvements were noted with an ejection fraction of up to 48.50% at follow-up.

CONCLUSION

For patients with potential hypocalcemia, monitoring calcium levels and dealing with hypocalcemia in time to avoid serious complications are important.

[Evaluation of chronic hypoparathyroidism course according to the Database of Endocrinology Research Centre]

BACKGRAUND

Currently high frequency of thyroid or parathyroid surgery is associated with significant increased incidence of hypoparathyroidism. Evaluation of the epidemiological and clinical features of chronic hypoparathyroidism is necessary to predict social-significant complications and to improve the quality of medical care.

AIMS

To estimate clinical and demographic features, different regimens and efficacy of conventional therapy in patients with chronic postsurgical and nonsurgical hypoparathyroidism.

MATERIALS AND METHODS

The cross-sectional, observational, continuous study was carried out based on Database of patients with chronic postsurgical and nonsurgical hypoparathyroidism of Endocrinology Research Centre, Moscow. 293 patients from 61 regions of the Russian Federation were included in this study. Statistical analysis was done on June 2020. The descriptive statistics are presented by medians (Ме) and the first and third quartiles (Q1; Q3) and by absolute and relative frequencies.

RESULTS

Hypoparathyroidism was most often recorded in women (85%) at the age of 43 [32; 52] years, after thyroid surgery. Less than a half of the study group had target indicators of serum calcium and phosphate levels (31% and 47%, respectively) despite ongoing treatment. A complex instrumental examination for the disease complications was performed in 58% of cases (n = 169). Among them, kidney disorders were detected in 38%, visual disturbance in 14%, brain calcification in 10%, arrhythmias in 4% and neuropsychiatric symptoms in 6%. Conventional therapy with calcium supplements and activated vitamin D analogues was noted in 75% of patients.

CONCLUSIONS

The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool for determining of optimal clinical and therapeutic approaches, as well as prognostic markers of disease complications.