Reversible pulmonary hypertension associated with vitamin C deficiency.
We describe the case of a 40-year-old female patient who developed severe pulmonary hypertension and life-threatening right-sided heart failure in association with dietary scurvy and iron deficiency. Supplementation with oral vitamin C and iron very likely contributed to her complete cure. Scurvy-associated pulmonary arterial hypertension could result from impaired availability of endothelial nitric oxide, but inappropriate activation of the hypoxia-inducible family (HIF) of transcription factors could play an even more important role. HIF coordinates the body's responses to hypoxia, and its activity is regulated by oxygen-dependent prolyl hydroxylases, which need vitamin C and iron as cofactors. Deficiency of these cofactors could lead to uncontrolled HIF activity and pulmonary vasoconstriction responsive to vitamin C and iron administration.
Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: Markku.Kupari@hus.fi.
Markku
M
Kupari
Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Janne
J
Rapola
D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000188:drug therapy; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D001206:Ascorbic Acid Deficiency / Q000150:complications* / Q000188:drug therapy*; D019587:Dietary Supplements; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D012614:Scurvy / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000502:physiology
D007501:Iron; D001205:Ascorbic Acid