title: Pseudoarthrosis and fracture: interaction between severe vitamin D deficiency and primary hyperparathyroidism.
abstract: A young woman with severe vitamin D deficiency presented with proximal muscle weakness, fragility fracture and pseudoarthrosis. On evaluation, she was found to have hypercalcaemia, a single parathyroid adenoma and an undetectable 25-hydroxyvitamin D level. She received parenteral cholecalciferol and subsequently underwent curative parathyroidectomy. Postoperatively, she had hungry bone syndrome, which she gradually recovered from with calcium and calcitriol replacement. Notably, her calcium levels were in the lower limit of normal range and associated with elevated alkaline phosphatase levels at postoperative Day 14. Follow-up for the next four years showed that the patient had remarkable symptomatic and radiological improvements. In this report, we discuss the pathophysiological interactions between vitamin D deficiency and associated primary hyperparathyroidism.
authors.affiliation: Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. bhadadask@rediffmail.com.
authors.forename: Ashu
authors.initials: A
authors.lastname: Rastogi
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Bhadada
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011542:Pseudarthrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012720:Severity of Illness Index; D012846:Singapore; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis*