Endocrine Abstracts

Introduction: A newborn baby boy of a family of Asian origin with an uncommon, but logical diagnosis.

Case: Of 8 days old, term baby boy. Normal pregnancy, spontaneous delivery, uncomplicated postnatal period. On day 5, jerking movements of the whole body. Fully breastfed, not feeding well lately. Medical and neurological clinical examination normal. Tonic-clonic epileptic fit during the 1 h of admission.

Blood results: Calcium 1.48 mmol/l, phosphate 3.52 mmol/l, magnesium 0.57 mmol/l, alkaline phosphatase 301 U/l.

EEG: During the EEG left sided focal fit with cyanosis; rhythmic 3/s spike-waves predominantly central with movements to the right side. Inter-ictal EEG normal.

EEG-monitoring: Series of rhythmic spike waves, lasting 1–3 min up to 10 times/h with bilateral focal fits.

Therapy: IV Calcium gluconate and magnesium. Convulsions stopped after the calcium level normalised.

Usual differentials were excluded. Observation of the mother revealed the likely diagnosis as she is of Asian origin and wears a full facial veil for religious reasons.

Further blood results: Parathyroid hormone 28 ng/l (normal 12–45 ng/l), 25-hydroxy-vitamin D 1.0 μg/l (normal 20–70 μg/l).

Mother’s blood results: Calcium 2.19 mmol/l, Phosphate 4.2 mg/dl und alkaline phosphatase 173 U/l, (all normal), 25-hydroxy-vitamin D <1.0 μg/l and Parathyroid hormone 61 ng/l (normal 12–45 ng/l).

Diagnosis: Congenital vitamin D deficiency with hypocalcaemic convulsions in a child born to a mother with vitamin D-deficiency and secondary hyperparathyroidism.

Discussion: Vitamin D deficiency in pregnant and lactating veiled immigrants is usually precipitated by the lack of sunlight due to religious dress codes. Newborns of veiled mothers do have significant lower vitamin D levels e.g. 10.4 μg/l (25 nmol/l) than newborns of unveiled mothers: 63 vs 15.8%.

Pregnant women with poor exposure to sunlight should have a good vitamin D-substitution. Newborns of veiled mothers should be examined and treated for vitamin D deficiency as soon as possible.