Vitamin D deficiency or pseudohypoparathyroidism?

Shruti Sastry , Jayde T. Hooven-Davis , Kara S. Hughan , Nursen Gurtunca
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Abstract

Severe vitamin D deficiency (VDD) typically presents with overt hypocalcemia, hypophosphatemia, high alkaline phosphatase (ALP) and high parathyroid hormone (PTH). The clinical presentation and the biochemical features in atypical cases of VDD can be similar to pseudohypoparathyroidism (PHP). We present 2 patients with atypical laboratory findings of severe VDD secondary to restrictive eating disorders. PHP was considered, given hyperphosphatemia rather than hypophosphatemia classically seen with severe VDD. Renal PTH resistance, mimicking PHP, was observed in both cases with high phosphorus and high PTH levels in the setting of severe VDD. Calcitriol was added to the treatment to normalize serum calcium levels and overcome PTH resistance. Hypocalcemia and hyperphosphatemia resolved and PTH normalized with calcium, cholecalciferol and calcitriol supplementations and dietary modification, eliminating the need for further workup for PHP.

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维生素D缺乏还是假性甲状旁腺功能减退?
严重的维生素D缺乏(VDD)通常表现为明显的低钙血症、低磷血症、高碱性磷酸酶(ALP)和高甲状旁腺激素(PTH)。不典型VDD的临床表现和生化特征与假性甲状旁腺功能低下(PHP)相似。我们报告了2例非典型实验室结果的严重VDD继发于限制性饮食失调。考虑到高磷血症,而不是严重VDD典型的低磷血症,考虑PHP。在严重VDD的情况下,在高磷和高PTH水平的两种情况下,均观察到肾PTH抵抗,模拟PHP。治疗中加入骨化三醇使血清钙水平恢复正常,克服甲状旁腺素抵抗。通过钙、胆骨化醇和骨化三醇的补充和饮食调整,低钙血症和高磷血症得以解决,甲状旁腺激素正常化,无需进一步检查PHP。
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来源期刊
Journal of Clinical and Translational Endocrinology: Case Reports
Journal of Clinical and Translational Endocrinology: Case Reports Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.10
自引率
0.00%
发文量
32
审稿时长
27 weeks
期刊介绍: The journal publishes case reports in a variety of disciplines in endocrinology, including diabetes, metabolic bone disease and osteoporosis, thyroid disease, pituitary and lipid disorders. Journal of Clinical & Translational Endocrinology Case Reports is an open access publication.
期刊最新文献
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