Endocrine Abstracts

Introduction: Vitamin D deficiency is a common disorder and may manifest as a musculoskeletal, neurological, mental disorder or neoplastic disease.

Case report: A 47 year old woman of Caucasian origin suffered from back, muscle, bone pain and severe depression for 8 years. She was ineffectively treated at the departments of Neurology, Psychiatry, Pain Clinic several times a year. Brain, bone CT, internal ultrasound, routine biochemistry analyses were normal. X-Ray – lumbar spine osteochondrosis, spondylosis. Finally, she could hardly walk due to muscle weakness and cramps, when ionized calcium (Ca+2) was measured for the first time. With the severe hypocalcemia (Ca+2 0.62 mmol/l (n 1.05–1.3)) she was admitted to the Endocrinology Department. Further investigations confirmed secondary hyperparathyroidism with the ‘empty bones’ syndrome and osteoporosis due to severe longstanding vitamin D deficiency with the plasma alkaline phosphatase (ALP) of 425 U/l (n 40–150), phosphorus of 0,99 mmol/l (n 0.74–1.52), 24 hour urine Ca of 0.6 mmol/24 hours (n 2.5 – 7.5), parathyroid hormone (PTH) of 94.9 pmol/l (n 1.2–7.3), serum 25-hydroxyvitamin D of <4 ng/ml (local laboratory reference range 20–32). 99mTC-sestamibi parathyroid and whole body scintigraphy revealed no pathology, spinal Dual-emission X-ray absorptiometry showed T score of −5.3 at L2-L4. The patient was treated with intramuscular cholecalciferol 200 000 U followed by oral alfacalcidol 1 μg/day and oral calcium carbonate 3 g/day for six months. During the follow up period the analyses improved gradually resulting in Ca+2 of 1.09 mmol/l, ALP of 129 U/l, PTH of 10.6 pmol/l. The patient’s overall condition improved significantly.

Conclusions: Severe vitamin D deficiency may remain unrecognised for many years, mimicking other disorders and leading to severe disability. Thus it has to be considered in all cases of unexplained, treatment resistant pain and weakness even the subject does not belong to the risk group.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.