{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T07:06:37Z","timestamp":1779865597840,"version":"3.53.1"},"reference-count":19,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Paget disease of bone (PDB) is a focal disorder of accelerated bone remodeling that typically presents with bone pain, deformity, or elevated alkaline phosphatase (ALP). Clinically significant hypocalcemia is uncommon and is usually associated with vitamin D deficiency and high bone turnover states. We report a 64-year-old woman who presented with altered mental status and severe hypocalcemia (total calcium 4.1\u2005mg\/dL [International System of Units (SI): 1.0\u2005mmol\/L]; reference range 8.5-10.1\u2005mg\/dL [SI: 2.1-2.5\u2005mmol\/L]) and markedly elevated ALP (1550\u2005U\/L; reference range 35-104\u2005U\/L). She had a history of progressive cranial enlargement and bilateral hearing loss. Laboratory evaluation revealed profound vitamin D deficiency. Skull radiography demonstrated extensive calvarial thickening with a classic \u201ccotton wool\u201d appearance, and bone scintigraphy showed intense tracer uptake throughout the cranial bones. 18F-sodium fluoride positron emission tomography\/computed tomography confirmed diffuse osteoblastic activity confined to the calvarium without evidence of malignant skeletal lesions. Hypocalcemia resolved with calcium and vitamin D repletion, and intravenous zoledronic acid was administered for persistently active Paget disease. This case highlights that severe vitamin D deficiency is the primary driver of hypocalcemia, while high bone turnover may amplify its severity, underscoring the need for metabolic correction before antiresorptive therapy.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag100","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:43:32Z","timestamp":1774442612000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe hypocalcemia in a patient with extensive cranial Paget disease: a diagnostic challenge"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-1978","authenticated-orcid":false,"given":"Yagmur","family":"Goksoy Solak","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Marmara University School of Medicine , Istanbul 34899 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