title: Hyperparathyroidism and malnutrition with severe vitamin D deficiency.
abstract: BACKGROUND
  Vitamin D deficiency and its associated problems are common in developing Asian countries and countries of the Middle East. Various factors, including poor nutritional status and other compounding factors such as dietary, cultural, ethnic, and environmental factors, play a major role in contributing to the poor calcium and vitamin D homeostasis. Vitamin D deficiency is thought to exacerbate signs and symptoms of hyperparathyroidism (HPT). In this overview, we present evidence of the impact of vitamin D and calcium deficiency on primary HPT (PHPT).
  
  
  METHODS
  We performed an evidence-based review of articles published in the English language between January 1960 and June 2008.
  
  
  RESULTS
  Level IV evidence suggests widespread calcium and vitamin D deficiency in developing countries (issue 1). Limited level IV evidence suggests malnutrition as a primary cause of calcium and vitamin D deficiency (issue 2). Level IV evidence suggests that calcium and vitamin deficiencies cause secondary HPT and possibly PHPT as well (issues 3 and 4). A literature search revealed only six studies that correlated vitamin D levels with clinical, biochemical, and pathologic features of PHPT (issue 5). These studies provide level IV evidence suggesting that vitamin D deficiency causes some specific clinical features of PHPT as well as exacerbating other features of the disease.
  
  
  CONCLUSIONS
  In the developing countries, which have severe vitamin D and calcium deficient population, PHPT patients present with advanced disease and particularly severe bone symptoms. There is presently only level IV evidence of vitamin D status affecting the clinical severity of PHPT.
authors.affiliation: Department of Endocrine Surgery, SGPGIMS, Lucknow 226014, Uttar Pradesh, India. amit@sgpgi.ac.in
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.forename: Sushil Kumar
authors.initials: SK
authors.lastname: Gupta
authors.forename: Ranjith
authors.initials: R
authors.lastname: Sukumar
mesh_terms: D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications*; D006996:Hypocalcemia / Q000150:complications*; D044342:Malnutrition / Q000150:complications*; D014808:Vitamin D Deficiency / Q000150:complications*