Abstract
The effect of intramuscular calcitriol was evaluated in five children (aged 1–16 years) with severe chronic renal failure and hyperparathyroidism [range of intact parathyroid hormone (PTH) 400–1,200 pg/ml]. All five children had been on oral calcitriol or 1α-hydroxyvitamin D3 treatment (5–20 ng/kg per day), but an adequate, efficacious dosage could not be achieved since any attempt of increasing the dosage resulted in severe hypercalcaemia (>2.9 mmol/l). Intramuscular calcitriol was given three times weekly for 5 months at an initial dosage of 65–70 ng/kg to all but one patient who received 100 ng/kg. In the first three patients, treatment resulted in an 86%–98% fall in serum PTH compared with baseline levels and serum calcium never exceeded 2.65 mmol/l, except for one episode of hypercalcaemia in one patient. In the last two patients, serum calcium rose above normal limits, thus calcitriol had to be discontinued several times and then restarted at a lower dosage (40 ng/kg); PTH fell by 61% and 73%, respectively, compared with basal values. All patients had very low pre-treatment levels of serum 1,25-dihydroxyvitamin D3 (5–15 pg/ml) which were normalized (35–56 pg/ml) by the intramuscular calcitrioltreatment. Serum phosphorus and magnesium did not vary in any of the five patients. No side effects were observed at the injection site. Intramuscular calcitriol seems a useful therapeutic option for patients with severe hyperparathyroidism associated with a high serum calcium level when treated with conventional oral calcitriol.
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References
Malluche HH, Faugere FC (1989) Renal osteodystrophy. N Engl J Med 321: 317–318
Mehls O, Salusky IB (1987) Recent advances and controversies in childhood renal osteodystrophy. Pediatr Nephrol 1: 212–223
Brown EM, Brennan MF, Hurwitz S, Windeck R, Marx SJ, Spiegel AM, Koehler JO, Gardner DJ, Aurbach GD (1978) Dispersed cells prepared from human parathyroid glands: distinct calcium sensitivity of adenomas vs primary hyperplasia. J Clin Endocrinol Metab 6: 267–275
Malluche H, Faugere MC (1990) Effects of 1.25 (OH)2 D3 administration on bone in patients with renal failure. Kidney Int 38: S48-S53
Slatopolsky E, Lopez-Hilker S, Delmez J, Dusso A, Brown A, Martin KJ (1990) The parathyroid-calcitriol axis in health and chronic failure. Kidney Int 38: S41-S47
Quarles LD, Davidai GA, Schwab SJ, Bartholomay DW, Lobaugh B (1988) Oral calcitriol and calcium: efficient therapy for uremic hyperparathyroidism. Kidney Int 34: 840–844
Napoli JL, Premanik BC, Royal PM, Reinhardt TA, Horst RL (1983) Intestinal synthesis of 24-keto-1.25 dihydroxyvitamin D3: a metabolite formed in vivo with high affinity for vitamin D cytosolic receptors. J Biol Chem 258: 9100–9107
Coburn JW (1990) Use of oral and parenteral calcitriol in the treatment of renal osteodystrophy. Kidney Int 38: S54-S61
Brickman AS, Coburn JW, Friedman GR, Okamura WH, Massry GW, Norman AW (1976) Comparison of effects of 1-alfa-hydroxyvitamin D3 and 1.25-dihydroxyvitamin D3 in man. J Clin Invest 57: 1540–1547
Slatopolsky E, Weerts C, Thielan J, Horst R, Harter H, Martin KJ (1984) Marked suppression of secondary hyperparathyroidism by intravenous administration of 1.25-dihydroxycholecalciferol in uremic patients. J Clin Invest 74: 2136–2143
Andress DL, Norris KC, Coburn JW, Slatopolsky E, Sherrard DJ (1989) Intravenous calcitriol in the treatment of refractory osteitis fibrosa of chronic renal failure. N Engl J Med 321: 274–279
Delmez J, Tindira PG, Grooms P, Dusso A, Windus DW, Slatopolsky E (1989) Parathyroid hormone suppression by intravenous 1.25-dihydroxyvitamin D. J Clin Invest 83: 1349–1355
Rodriguez M, Felsenfeld AJ, Williams C, Pederson JA, Llach F (1991) The effect of long-term intravenous calcitriol administration on parathyroid function in hemodialysis patients. J Am Soc Nephrol 2: 1014–1020
Trachtman H, Gauthier B (1987) Parenteral calcitriol for treatment of severe renal osteodystrophy in children with chronic renal insufficiency. J Pediatr 110: 966–970
Cantley LK, Russell J, Lettieri D, Sherwood LM (1985) 1.25-dihydroxyvitamin D3 suppresses parathyroid hormone secretion from parathyroid cells in tissue culture. Endocrinology 117: 2114–2119
Brumbaugh PF, Hughes MR, Hausler MR (1975) Cytoplasmic and nuclear binding components for 1.25-dihydroxyvitamin D3 in chick parathyroid glands. Proc Natl Acad Sci USA 72: 4871–4875
Silver J, Naveh-Many T, Mayer H, Schmelzer HJ, Popovtzer MM (1986) Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo by the rat. J Clin Invest 78: 1296–1301
Russell J, Lettieri D, Sherwood LM (1986) Suppression by 1.25 (OH)2 D3 of transcription of the parathyroid hormone gene. Endocrinology 119: 2864–2866
Korkor AB (1987) Reduced binding of 1.25-dihydroxyvitamin D3 in the parathyroid glands of patients with renal failure. N Engl J Med 316: 1573–1577
Malluche HH, Goldstein DA, Maluche SG (1980) Effects of 6 months therapy with 1.25 (OH)2 D3 on bone disease of dialysis patients. Contrib Nephrol 18: 98–104
Klaus G, Schaefer F, Soergel M, Ritz E, Mehls O (19917 Oral calcitriol pulse therapy is effective and safe for treatment of secondary hyperparathyroidism. Pediatr Nephrol 5: C24
Dall'Amico R, Montini G, Murer G, Maiocco F, Andretta B, Luisetto G, Zacchello G (1991) Subcutaneous calcitriol administration in CAPD children: absorption kinetic study. J Am Soc Nephrol 2: 634
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Claris-Appiani, A., Ardissino, G.L., Tischer, M.C. et al. Intramuscular calcitriol for uraemic children with severe hyperparathyroidism and hypercalcaemia. Pediatr Nephrol 8, 719–723 (1994). https://doi.org/10.1007/BF00869100
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DOI: https://doi.org/10.1007/BF00869100