>Can vitamin D deficiency mask hypercalcaemia of
>primary hyperparthyroidism?
A 'common' problem especially where, because of dietary habits for example,
vitamin D deficiency is common; e.g. in one series from India, half of the
patients with primary hyperparathyroidism had hypovitaminosis D and various
degrees of masking of hypercalcaemia.
May I ask two questions related to this scenario please:
- We were taught that vitamin D status should be corrected if possible
before dealing with (and even attempting to diagnose) parathyroid
problems. But there are some suggestions that in patients with a normal
renal function, phosphate excretion or the degree of the increase of ALP,
etc. would help with the diagnosis of hyperparathyroidism superimposed on
vitamin D deficiency. How? Are nomograms used?
- Can the secondary hyperparathyroidism of hypovitaminosis D, i.e. without
hyperphosphataemia, eventually lead to tertiary hyperparathyroidism?? If
so, does the low level of Ca-binding proteins in Chief cells play a role?
Thanks
Reza Morovat
Clinical Biochemist
Institute of Neurology
London
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