Decreased Parathyroid Hormone Levels Despite Persistent Hypocalcemia in Patients with Kidney Failure Recovering from Septic Shock

Fabiano Pinheiro   da   Silva; Fernando   Godinho   Zampieri; Hermes   Vieira   Barbeiro; Francisco   Torggler   Filho; Alessandra   Carvalho   Goulart; Vanda      Jorgetti; Irineu   Tadeu   Velasco; Luiz Monteiro da   Cruz   Neto; Heraldo Possolo   de   Souza

Abstract

Introduction: Hypocalcemia is a common and poorly understood finding in critically ill patients. The current study was designed to assess the association of ionized calcium, vitamin D, phosphorus and Parathyroid hormone levels in a cohort of patients with and without kidney dysfunction admitted for sepsis or non-infectious causes.

Methods: Prospective cohort clinical and biochemical study.

Results: We confirmed that hypocalcemia and hypovitaminosis D are a common finding in critically ill patients. Parathyroid hormone levels significantly rise in septic shock. In the recovery phase, however, despite persistent hypocalcemia, Parathyroid hormone levels abruptly decrease in patients with kidney dysfunction, but not in patients with normal renal function.

Conclusions: The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected.

Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.

Keywords: Calcium, critical illness, parathyroid hormone, renal failure, sepsis, vitamin D.