A woman with hypophosphataemia and raised alkaline phosphatase
| Autor: | Wing Sun Chow, Annie W.C. Kung, Kathryn C.B. Tan, Joanne K Y Lam, Annette W.K. Tso, Karen S.L. Lam |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Hypercalcaemia Calcitriol Hypophosphatemia Parathyroid hormone chemistry.chemical_compound Internal medicine medicine Vitamin D and neurology Humans Hypercalciuria Vitamin D Aged General Environmental Science Parathyroidectomy business.industry Hyperparathyroidism General Engineering General Medicine Alkaline Phosphatase Vitamin D Deficiency medicine.disease Endocrinology chemistry General Earth and Planetary Sciences Female Secondary hyperparathyroidism Cholecalciferol business Primary hyperparathyroidism medicine.drug |
| Zdroj: | BMJ. 340:b5564-b5564 |
| ISSN: | 1468-5833 0959-8138 |
| Popis: | A 73 year old woman was referred because of hypophosphataemia and raised serum alkaline phosphatase. She was a chronic hepatitis B carrier and regular monitoring had shown a persistently raised alkaline phosphatase (415-495 U/l; normal range 47-124). All other liver enzymes were within the normal range, and ultrasound of the liver was unremarkable. Further assessment showed low serum phosphate (0.51-0.63 mmol/l; 0.88-1.45), but normal albumin adjusted calcium (2.53-2.63 mmol/l; 2.24-2.63) and creatinine (40 µmol/l; normal 49-82). Her serum parathyroid hormone was extremely high at 689 ng/l (normal 9-52), serum calcidiol (25-hydroxyvitamin D) was low at 23.5 nmol/l (normal >50), and serum calcitriol (1,25-dihydroxycalciferol) was raised at 240.5 pmol/l (60.2-158.6). She was diagnosed with vitamin D insufficiency with secondary hyperparathyroidism and was prescribed cholecalciferol 800 IU/day. After three months of treatment, serum phosphate remained persistently low at 0.52 mmol/l and she had developed hypercalcaemia (albumin adjusted calcium 2.73 mmol/l). Her 24 hour urine for calcium was normal (7.1 mmol/day; 2.0-7.4) and parathyroid hormone remained raised at 691 ng/l. ### 1 What is the most likely diagnosis? #### Short answer The patient has primary hyperparathyroidism; vitamin D replacement seemed to unmask the hypercalcaemia. #### Long answer Primary hyperparathyroidism is a common endocrine disorder. Up to 80% of patients have no symptoms of hypercalcaemia and only a small proportion present with associated complications such as hypercalciuria, renal stones, osteoporosis, and fractures. Vitamin D insufficiency is also a common problem worldwide, which often goes unrecognised. A serum calcidiol concentration of below 50 nmol/l is suggestive of vitamin D insufficiency. Recently, the National Institute of Health of the United States recommended a calcidiol value of greater than 75 nmol/l to reduce fracture risk, improve lower extremity function, and protect against development of colorectal cancer. … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|