A Spectrum of Clinical Presentations in Seven Japanese Patients with Vitamin D Deficiency

Kubota, Takuo; Kotani, Tomoo; Miyoshi, Yoko; Santo, Yoko; Hirai, Haruhiko; Namba, Noriyuki; Shima, Masasuke; Shimizu, Kazuo; Nakajima, Shigeo; Ozono, Keiichi

doi:10.1297/cpe.15.23

Cited by 14 publications

(15 citation statements)

References 15 publications

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“…Playing outside twice a week or less was regarded as insufficient sun exposure. Laboratory data without serum FGF23 levels of 3 DR patients and those with serum FGF23 levels of 2 HR patients were included in previous publications by our group [9,21]. Measurement of serum FGF23 levels was approved by the institutional review board of Osaka University Hospital and written informed consent was obtained from the parents or guardians of the patients.…”

Section: Methodsmentioning

confidence: 99%

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Serum Fibroblast Growth Factor 23 Is a Useful Marker to Distinguish Vitamin D-Deficient Rickets from Hypophosphatemic Rickets

et al. 2014

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Background/Aims: Vitamin D-deficient rickets (DR) has recently re-emerged among developed countries. Vitamin D deficiency can influence biochemical results of patients with fibroblast growth factor 23 (FGF23)-related hereditary hypophosphatemic rickets (HR), making differential diagnosis difficult. In the present study we evaluated the utility of serum FGF23 levels in the diagnosis of DR and during its treatment. Methods: The study group comprised 24 children with DR and 8 children with HR. Serum FGF23 levels and bone metabolism-related measurements were assessed. Results: Serum FGF23 levels in patients with DR were less than 19 pg/ml, while those in patients with HR were more than 57 pg/ml. There were significant differences in serum levels of calcium, phosphate, parathyroid hormone, and 1,25-dihydroxyvitamin D, as well as tubular maximum phosphate reabsorption per glomerular filtration rate between patients with DR and HR, but these values were not fully mutually exclusive. In addition, serum FGF23 and phosphate levels were increased following treatment. Conclusion: Serum FGF23 level is the most critical biochemical marker for distinguishing DR from HR and might be a good indicator of biochemical response to the intervention. Serum FGF23 levels show utility for the diagnosis of DR and in the assessment of its response to treatment.

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Section: Methodsmentioning

confidence: 99%

“…Increased numbers of patients with vitamin D deficiency have been reported among children in recent years throughout the world [3,4,5], including Japan [6,7,8,9]. Circulating 25-hydroxyvitamin D [25(OH)D] concentration is the best clinical indicator of vitamin D repletion in the body.…”

Section: Introductionmentioning

confidence: 99%

Serum Fibroblast Growth Factor 23 Is a Useful Marker to Distinguish Vitamin D-Deficient Rickets from Hypophosphatemic Rickets

et al. 2014

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“…Anxiety hyperventilation was correspondingly common in our study (13%) having overt tetany in 12 out of 14 patients and was predominant in females. Hypocalcemia and tetany by reason of VDD were similarly common [10] . Malnutrition, malabsorption disorders, for example, Celiac disease, decreased sunlight exposure and urbanization was associated with VDD [11] .…”

Section: Resultsmentioning

confidence: 99%

A Study of Tetany among the Saudi Population

Alshareef

Alkathiri

Rashidy

et al. 2018

Egyptian Journal of Hospital Medicine

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Aim of the work: studies mentioning etiological distribution of tetany are rare and responsiveness concerning it is poor among physicians so, we tried to describe different causes of tetany beyond the decrease in total serum calcium level. Methods: patients with overt or latent tetany were assessed clinically and from laboratory investigations. Initial examinations completed were serum calcium, potassium and arterial blood gas analysis. Both ionized and total calcium were evaluated and corrected according to serum albumin level. Depending on initial reports, additional tests were completed for example, alkaline phosphatase, serum phosphate, parathyroid hormone and magnesium levels; and urine potassium, calcium and chloride levels. Results: Gitelman's syndrome (GS), Bartter's syndrome (BS), recurrent vomiting, anxiety hyperventilation, vitamin D3 deficiency (VDD), idiopathic hypoparathyroidism (IHP), postoperative hypoparathyroidism (PHP), acute pancreatitis, tumor lysis syndrome (TLS) and hypomagnesemia were the different causes of tetany identified. Out of 106 patients, total serum calcium was normal in 82 patients with metabolic or respiratory alkalosis (GS, BS, recurrent vomiting, and anxiety hyperventilation). Total calcium was low only in 24 patients (in VDD, IHP, PHP, acute pancreatitis, TLS and hypomagnesemia). Ionized calcium was low in all patients. GS was the most common (38%). Recurrent vomiting (19%), anxiety hyperventilation (13%), and VDD (11%) were also common. PHP was less common (4%); acute pancreatitis, TLS, hypomagnesemia and IHP were uncommon. Conclusion: tetany has diverse etiologies. Both metabolic and respiratory alkalosis caused a decrease in ionized calcium and are responsible for the majority of cases of tetany. Causes other than decreased total calcium should be kept in mind for early etiological diagnosis of tetany.

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“…However, the present patient exhibited a normal level of serum phosphorus. It has been reported that patients with rickets due to vitamin D deficiency display normal to higher levels of serum phosphorus, suggesting that the absence of a low level of inorganic phosphorus is not necessary for a diagnosis of rickets (14).…”

Section: Discussionmentioning

confidence: 99%

Osteomalacia, Severe Thoracic Deformities and Respiratory Failure in a Young Woman with Anorexia Nervosa

2015

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The recent trends in avoiding sunbathing and eating fewer fish products have resulted in a high prevalence of vitamin D deficiency in the general Japanese population. We herein report the case of a young woman with enduring anorexia nervosa (AN) who suffered from osteomalacia, thoracic deformities and respiratory failure. Her vitamin D deficiency had been overlooked for years. Although the serum 25-hyroxyvitamin D [25(OH)D] level is a marker of vitamin D stores, it is not routinely examined because the cost is not covered by the national health insurance program. However, measuring the serum 25(OH)D levels in AN patients with hypocalcemia is recommended to prevent osteomalacia and osteoporosis.

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A Spectrum of Clinical Presentations in Seven Japanese Patients with Vitamin D Deficiency

Cited by 14 publications

References 15 publications

Serum Fibroblast Growth Factor 23 Is a Useful Marker to Distinguish Vitamin D-Deficient Rickets from Hypophosphatemic Rickets

Serum Fibroblast Growth Factor 23 Is a Useful Marker to Distinguish Vitamin D-Deficient Rickets from Hypophosphatemic Rickets

A Study of Tetany among the Saudi Population

Osteomalacia, Severe Thoracic Deformities and Respiratory Failure in a Young Woman with Anorexia Nervosa

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