Joanne K Y Lam, Karen S L Lam, Kathryn C B Tan, Wing-Sun Chow, Annette W K Tso, Annie W C Kung et al
Lam J K Y, Lam K S L, Tan K C B, Chow W, Tso A W K, Kung A W C et al.
A woman with hypophosphataemia and raised alkaline phosphatase
BMJ 2010; 340 :b5564
doi:10.1136/bmj.b5564
Primary hyperparathyroidism cannot be diagnosed until Vitamin D deficiency has been corrected
Although they have not said so explicitly, the authors of this report
have nicely illustrated that the diagnosis of primary hyperparathyroidism
(PHPT) should only be made when Vitamin D deficiency has either been
excluded or corrected.
A patient with hypercalcaemia and elevated PTH level, but low urine
Calcium/creatinine clearance ratio, could either have familial benign
hypercalcaemia with hypocalciuria (FBHH) or PHPT with coexisting Vitamin D
deficiency.
Furthermore, depending of the degree of concomitant secondary
hyperparathyrodism, Vitamin D deficiency can be associated with serum
Calcium levels that are low, normal, or even slightly elevated.
Thus, in order to avoid performing uncecessary parathyroidectomies
(and to ensure that necessary ones are performed), the serum and urine
biochemistry should be repeated once the patient has been rendered Vitamin
D replate.
Following surgery for PHPT, a proportion of patients develop
transient, but severe, hypocalcaemia -a phenomenon that is traditionaly
referred to as "hungry bone disease". Although this has never been
formally investigated, it is highly likely that patients with unrecognised
severe Vitamin D deficiency are at much greater risk of exhibiting this
phenomenon.
Competing interests:
None declared
Competing interests: No competing interests