COVID-19 Induced Hypoparathyroidism

Katharine Whitehurst; Lina Kayali; Kamal Chokkalingam

doi:10.1530/endoabs.86.P31

Case history: A 55-year-old man presented to the Emergency Department with worsening breathlessness 11 days after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS CoV 2). He reported ongoing diarrhoea, starting 1 week prior to the SARS CoV 2 infection. He was previously fit and well, on no regular medication. All clinical observations within normal limits and there were no significant examination findings.

Results and treatment: 3 Months Later Parathyroid antibodies-Negative Adjusted Calcium-2.08 mmol/l Phosphate-1.4 mmol/l PTH-6 ng/l Magnesium-0.82 mmol/L

Final Diagnosis: SARS CoV 2 infection-induced hypoparathyroidism, complicated by campylobacter diarrhoea (resolved). Treatment: Adcal-D3 2 tablets daily and Alfacalcidol 1 microgram daily.


	Day 1	Day 2	Day 11(discharged)
U&E	Sodium-127 mmol/l (133-146) Potassium-3 mmol/l (3.5-5.3) eGFR-58 ml/min		Sodium-Normal Potassium-Normal eGFR->90 ml/min
Bone Profile		Adjusted Calcium-0.98 mmol/l (2.2-2.6) Phosphate-1.01 mmol/l (0.74-1.62) ALP-78 U/l (40-150) PTH-5 ng/l (15-68) Magnesium-0.52 mmol/l (0.7-1.0) Vitamin D-34 nmol/l (50-200)	Adjusted Calcium-1.96 mmol/L PTH-4 ng/L Magnesium-0.92 mmol/L
Other	CRP-41 mg/l (0-10) Serum osmolality-267 mosmol/kg (280-300)	Stool culture-Campylobacter sp. ECG-Prolonged QTc
Provisional Diagnosis	Hypovolaemic hyponatraemia and hypokalaemia secondary to diarrhoea	Hypocalcaemia secondary to hypomagnesaemia (campylobacter diarrhoea)	Resolving electrolyte disturbances secondary to campylobacter diarrhoea
Treatment	Intravenous fluids	Intravenous replacement of calcium and magnesium	Cholecalciferol 20,000 units once weekly for 6 weeks, Adcal-D3 4 tablets daily, Alfacalcidol 0.5 micrograms once weekly

Conclusions: Hypocalcemia is a prevalent symptom of SARS CoV 2 infection, but is normally self-resolving. Several reports have shown SARS CoV 2 infection leading to autoimmune diseases but rarely involve the parathyroid gland. Three case studies have described SARS CoV 2 infection-induced hypoparathyroidism, but none with as profound hypocalcaemia requiring ongoing active vitamin D therapy.

Endocrine Abstracts

P31