Skip to main content

Advertisement

SpringerLink
Log in

Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Vitamin D deficiency and its associated problems are common in developing Asian countries and countries of the Middle East. Various factors, including poor nutritional status and other compounding factors such as dietary, cultural, ethnic, and environmental factors, play a major role in contributing to the poor calcium and vitamin D homeostasis. Vitamin D deficiency is thought to exacerbate signs and symptoms of hyperparathyroidism (HPT). In this overview, we present evidence of the impact of vitamin D and calcium deficiency on primary HPT (PHPT).

Methods

We performed an evidence-based review of articles published in the English language between January 1960 and June 2008.

Results

Level IV evidence suggests widespread calcium and vitamin D deficiency in developing countries (issue 1). Limited level IV evidence suggests malnutrition as a primary cause of calcium and vitamin D deficiency (issue 2). Level IV evidence suggests that calcium and vitamin deficiencies cause secondary HPT and possibly PHPT as well (issues 3 and 4). A literature search revealed only six studies that correlated vitamin D levels with clinical, biochemical, and pathologic features of PHPT (issue 5). These studies provide level IV evidence suggesting that vitamin D deficiency causes some specific clinical features of PHPT as well as exacerbating other features of the disease.

Conclusions

In the developing countries, which have severe vitamin D and calcium deficient population, PHPT patients present with advanced disease and particularly severe bone symptoms. There is presently only level IV evidence of vitamin D status affecting the clinical severity of PHPT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carling T, Kindmark A, Hellman P et al (1995) Vitamin D receptor genotypes in primary hyperparathyroidism. Nat Med 1:1309–1311

    Article  PubMed  CAS  Google Scholar 

  2. Carling T, Rastad J, Szabo E et al (2000) Reduced parathyroid vitamin D receptor messenger ribonucleic acid levels in primary and secondary hyperparathyroidism. J Clin Endocrinol Metab 85:2000–2003

    Article  PubMed  CAS  Google Scholar 

  3. Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agens Chest 95(Suppl):2S–4S

  4. Heinrich S, Schafer M, Rousson V et al (2006) Evidence based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168

    Article  PubMed  Google Scholar 

  5. Marwaha RK, Tandon N, Reddy DR et al (2005) Vitamin D and bone mineral density status on healthy school children in northern India. Am J Clin Nutr 82:477–482

    PubMed  CAS  Google Scholar 

  6. Sachan A, Gupta V, Das V et al (2005) High prevalence of vitamin D deficiency among patients women and their newborns in northern India. Am J Clin Nutr 81:1060–1064

    PubMed  CAS  Google Scholar 

  7. Harinarayan CV (2005) Prevalence of vitamin D deficiency in post menopausal south Indian women. Osteoporos Int 16:397–402

    Article  PubMed  CAS  Google Scholar 

  8. Arya V, Bhambri R, Godbole MM et al (2004) Vitamin D status and its relationship with bone mineral density in healthy Asian Indians. Osteoporos Int 15:56–61

    Article  PubMed  CAS  Google Scholar 

  9. Webb AR, Pilbeam C, Hanafin N et al (1990) An evaluation of the relative contribution of exposure to sunlight and to diet to the circulating concentration of 25 hydroxyvitamin D in an elderly nursing home population of Boston. Am J Clin Nutr 51:1075–1081

    PubMed  CAS  Google Scholar 

  10. Lips P (2007) Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem 103:620–625

    Article  CAS  Google Scholar 

  11. Hollis BW, Wagner CL (2005) Normal serum vitamin D levels. N Engl J Med 352:515–516

    Article  PubMed  CAS  Google Scholar 

  12. Bhalala U, Desai M, Parakh P et al (2007) Subclinical hypovitaminosis D among exclusively breastfed young infants. Indian Pediatr 44:897–901

    PubMed  CAS  Google Scholar 

  13. Zargar AH, Ahamad S, Masoodi SR et al (2007) Vitamin D status in apparently healthy adults in Kashmir valley of Indian subcontinent. Postgrad Med J 83:713–716

    Article  PubMed  CAS  Google Scholar 

  14. Islam MZ, Akhtaruzzaman M, Lamberg C et al (2006) Hypovitaminosis D is common in both veiled and non veiled Bangladeshi women. Asia Pac J Clin Nutr 15:81–87

    PubMed  CAS  Google Scholar 

  15. Rahman SA, Chee WS, Yassin Z et al (2004) Vitamin D status among postmenopausal Malaysian women. Asia Pac J Clin Nutr 13:255–260

    PubMed  CAS  Google Scholar 

  16. Brustad M, Sandanger T, Aksnes L et al (2004) Vitamin D status in a rural population of northern Norway with high fish liver consumption. Public Health Nutr 7:783–789

    PubMed  CAS  Google Scholar 

  17. Alagol F, Shihadeh Y, Boztepe H et al (2000) Sunlight exposure and vitamin D deficiency in Turkish women. J Endocrinol Invest 23:172–173

    Google Scholar 

  18. Gannage-Yared MH, Chemali R, Yaacoub N et al (2000) Hypovitaminosis D in a sunny country: relation to life style and bone markers. J Bone Miner Res 15:1856–1862

    Article  PubMed  CAS  Google Scholar 

  19. El-Haji Fuleihan G, Nabulsi M, Choucair M, et al. (2001) Hypovitaminosis D in healthy school children Pediatrics 107:E53

  20. Gannage-Yared MH, Brax H, Asmar A et al (1998) Vitamin D status in aged population: study of Lebanese population. Presse Med 27:900–904

    PubMed  CAS  Google Scholar 

  21. Sedrani SH, Elidrissy AW, El Arabi KM et al (1983) Sunlight and vitamin D status in normal Saudi subjects. Am J Clin Nutr 38:129–132

    PubMed  CAS  Google Scholar 

  22. Hashemipour S, Larijani B, Adibi H et al (2004) Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 4:38

    Article  PubMed  Google Scholar 

  23. Goswami R, Gupta N, Goswami D et al (2000) Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects in Delhi. Am J Clin Nutr 72:472–475

    PubMed  CAS  Google Scholar 

  24. Balasubramanian K, Rajeswari J, Gulab et al (2003) Varying role of vitamin D deficiency in the etiology of rickets in young children vs adolescents in northern India. J Trop Pediatr 49:201–206

    Article  PubMed  CAS  Google Scholar 

  25. Clements TL, Henderson SL, Adams JS et al (1982) Increased skin pigment reduces the capacity of skin to synthesize vitamin D3. Lancet 1:74–76

    Article  Google Scholar 

  26. Taha SA, Dost SM, Sedrani SH (1984) 25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates. Pediatr Res 18:739–744

    Article  PubMed  CAS  Google Scholar 

  27. Sedrani SH (1984) Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab 28:181–185

    Article  PubMed  CAS  Google Scholar 

  28. Agarwal KS, Mughal MZ, Upadhyay P et al (2002) The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India. Arch Dis Child 87:111–113

    Article  PubMed  CAS  Google Scholar 

  29. Tiwari L, Puliyel JM (2004) Vitamin D level in slum children in Delhi. Indian Pediatr 41:1076–1077

    PubMed  Google Scholar 

  30. Puri S, Marwaha RK, Agarwal N et al (2008) Vitamin D status of apparently healthy school girls from two different socioeconomic strata in Delhi: relation to nutrition and lifestyle. Br J Nutr 99:876–882

    Article  PubMed  CAS  Google Scholar 

  31. Vupputuri MR, Goswami R, Gupta N et al (2006) Prevalance and functional significance of 25-hydroxyvitamin D deficiency and vitamin D receptor gene polymorphisms in Asian Indians. Am J Clin Nutr 83:1411–1419

    PubMed  CAS  Google Scholar 

  32. Harinarayan CV, Ramalakshmy T, Prasad UV et al (2007) High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr 85:1062–1067

    PubMed  CAS  Google Scholar 

  33. Anonymous (1996) Food composition table. In: Gopalan C, Sastri BVR, Balasubramanyam SC (eds) Nutritive value of Indian foods. National Institute of Nutrition ICMR, Hyderabad, India, pp 92–94 (Appendix 1)

    Google Scholar 

  34. Oginni LM, Worsfold M, Oyelami OA et al (1996) Etiology of rickets in Nigerian children. J Pediatr 128:692–694

    Article  PubMed  CAS  Google Scholar 

  35. Pettifor JM, Ross P, Wang J et al (1978) Rickets in children of rural origin in South Africa: is low dietary calcium a factor? J Pediatr 92:320–324

    Article  PubMed  CAS  Google Scholar 

  36. Fischer PR, Rahman A, Cimma JP et al (1999) Nutritional rickets without vitamin D deficiency in Bangladesh. J Trop Pediatr 45:291–293

    Article  PubMed  CAS  Google Scholar 

  37. Awumey EM, Mitra DA, Hollis BW et al (1998) Vitamin D metabolism is altered in Asian Indians in the southern United States: a clinical research center study. J Clin Endocrinol Metab 83:169–173

    Article  PubMed  CAS  Google Scholar 

  38. Russel J, Lettieri D, Sherwood LM et al (1983) Direct regulation by calcium of cytoplasmic messenger ribonucleic acid coding for pre-pro parathyroid hormone in isolated bovine parathyroid cells. J Clin Invest 72:1851–1855

    Article  Google Scholar 

  39. Naveh-Many T, Friedlander MM, Mayer H et al (1989) Calcium regulates parathyroid hormone messenger ribonucleic acid (mRNA) but not calcitonin mRNA in vivo in the rat: dominant role of 1, 25-dihydroxyvitamin D. Endocrinology 125:275–280

    Article  PubMed  CAS  Google Scholar 

  40. Naveh-Many T, Rahamimov R, Livini N et al (1995) Parathyroid cell proliferation in normal and chronic renal failure rats: the effects of calcium, phosphate and vitamin D. J Clin Invest 96:1786–1793

    Article  PubMed  CAS  Google Scholar 

  41. Ihimi Y, Russell J, Sherwood LM (1990) Regulation of calcium and 1,25(OD) 2D3 of cell proliferation and function of bovine parathyroid cells in culture. J Bone Miner Res 5:755–760

    Article  Google Scholar 

  42. Tsukamoto Y, Moriya R, Nagaba Y et al (1995) Effect of administering calcium carbonate to treat secondary hyperparathyroidism in nondialyzed patients with chronic renal failure. Am J Kidney Dis 25:879–886

    Article  PubMed  CAS  Google Scholar 

  43. Pettifor JM (2007) Vitamin D and or calcium deficiency rickets in infants and children: a concern for developing countries. Indian Pediatr 44:893–894

    PubMed  Google Scholar 

  44. Silver J, Russell J, Sherwood LM (1985) Regulation by vitamin D metabolites of messenger ribonucleic acid for prepro parathyroid hormone in isolated bovine parathyroid cells. Proc Natl Acad Sci U S A 82:4270–4273

    Article  PubMed  CAS  Google Scholar 

  45. Nygren P, Larsson R, Johansson H et al (1988) 1,25(OH)2O3 inhibits hormone secretion and proliferation but not functional dedifferentiation of cultured bovine parathyroid cells. Calcif Tissue Int 43:213–218

    Article  PubMed  CAS  Google Scholar 

  46. Kremer R, Bolivar I, Golzman D et al (1989) Influence of calcium and 1,25-dihydroxicholecalciferol on proliferation and proto-oncogene expression in primary cultures of bovine parathyroid cells. Endocrinology 125:935–941

    Article  PubMed  CAS  Google Scholar 

  47. McKane WR, Khosla S, Egan KS (1996) Role of calcium intake in modulating age-related increases in parathyroid function and bone resorption. J Clin Endocrinol Metab 81:1699–1703

    Article  PubMed  CAS  Google Scholar 

  48. Villareal DT, Civitelli R, Chines A et al (1991) Subclinical vitamin D deficiency in post menopausal women with low vertebral bone mass. J Clin Endocrinol Metab 72:628–634

    Article  PubMed  CAS  Google Scholar 

  49. Mezquita-Raya P, Munoz-Torres M, Luna JD et al (2001) Relationship between vitamin D insufficiency, bone density and bone metabolism in healthy postmenopausal women. J Bone Miner Res 16:1408–1415

    Article  PubMed  CAS  Google Scholar 

  50. Holick MF (2000) Vitamin D the unappreciated D-lightful hormone that is important for skeletal and cellular growth. Curr Opin Endocrinol Diabetes 9:87–98

    Article  Google Scholar 

  51. Need AG, O’Loughlin PD, Morris HA et al (2008) Vitamin D metabolites and calcium absorption in severe vitamin D deficiency. J Bone Miner Res 23:1859–1863

    Article  PubMed  CAS  Google Scholar 

  52. Holick MF, Siris ES, Binkley N et al (2005) Prevalance of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 90:3215–3224

    Article  PubMed  CAS  Google Scholar 

  53. Holick MF, Garabedian M (2006) Vitamin D: photobiology, metabolism mechanism of action, and clinical applications. In: Favus MJ (ed) Primer on the metabolic bone disease and disorders of mineral metabolism, 6th edn. American Society for Bone and Mineral Research, Washington, DC, pp 129–137

    Google Scholar 

  54. Bouillon R (2001) Vitamin D: from photosynthesis metabolism and action to clinical applications. In: DeGroot LJ, Jameson LI (eds) Endocrinology. Saunders, Philadelphia, pp 1009–1028

    Google Scholar 

  55. DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(Suppl):1689S–1696S

    PubMed  CAS  Google Scholar 

  56. Dusso AS, Brown AHJ, Slatopolsky E (2005) Vitamin D. Am J Phys Renal Physiol 289:F8–F28

    Article  CAS  Google Scholar 

  57. Holick MF (2006) High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 81:353–373

    Article  PubMed  CAS  Google Scholar 

  58. Bischoff-Ferrari HA, Giovannucci E, Willett WC et al (2006) Estimation of optimal serum concentrations of 25 hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18

    PubMed  CAS  Google Scholar 

  59. Chapuy MC, Prezios P, Maamer M et al (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporosis Int 7:439–443

    Article  CAS  Google Scholar 

  60. Boonen S, Bischoff-Ferrari HA, Cooper C et al (2006) Addressing the musculoskeletal components of fracture risk with calcium and vitamin D: a review of the evidence. Calcif Tissue Int 78:257–270

    Article  PubMed  CAS  Google Scholar 

  61. Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequence for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501

    Article  PubMed  CAS  Google Scholar 

  62. Halloran BP, Castro ME (1989) Vitamin D Kinetics in vivo: effect of 1,25-dihydroxyvitamin D administration. Am J Physiol 256:E686–E691

    PubMed  CAS  Google Scholar 

  63. Halloran BP, Bikle DD, Levenes MJ et al (1986) Chronic 1,25-dihydroxyvitamin D3 administration in rat reduces serum concentration of 25-hydroxyvitamin D by increasing metabolic clearance rate. J Clin Invest 78:622–628

    Article  PubMed  CAS  Google Scholar 

  64. Clements MR (1989) The problem of rickets in UK Asians. J Hum Nutr Diet 2:105–116

    Article  Google Scholar 

  65. Holick MF (2006) Resurrection of vitamin D deficiency and rickets. J Clin Invest 116:2062–2072

    Article  PubMed  CAS  Google Scholar 

  66. Pettifor JM (2005) Vitamin D deficiency and nutritional rickets in children. In: Feldman D, Pike JW, Glorieux FH (eds) Vitamin D, 2nd edn. Elsevier Academic, Boston, pp 1065–1084

    Google Scholar 

  67. Aaron JE, Gallagher JC, Anderson J et al (1974) Frequency of osteomalacia and osteoporosis in fractures of the proximal femur. Lancet 1:229–233

    Article  PubMed  CAS  Google Scholar 

  68. Pettifor JM (1994) Privational rickets: a modern prespective. J R Soc Med 87:723–725

    PubMed  CAS  Google Scholar 

  69. Pettifor JM (2005) Rickets and vitamin D deficiency in children and adolescents. Endocrinol Metab Clin N Am 34:537–553

    Article  CAS  Google Scholar 

  70. Henderson JB et al (1987) The importance of limited exposure to ultraviolet radiation and dietary factors in the etiology of Asian rickets: a risk-factor model. Q J Med 63:413–425

    PubMed  CAS  Google Scholar 

  71. Thacher TD et al (1999) A companion of calcium, vitamin D or both for nutritional rickets in Nigerian children. N Engl J Med 41:563–568

    Article  Google Scholar 

  72. DeLucia MC, Mitnick ME, Carpenter TO (2003) Nutritional rickets with normal circulating 25-hydroxyvitamin D: a call for reexamining the role of dietary calcium intake in North American infants. J Clin Endocrinol Metab 88:3539–3545

    Article  PubMed  CAS  Google Scholar 

  73. Clements MR, Johnson L, Fraser DR (1987) A new mechanism for induced vitamin D deficiency in calcium deprivation. Nature 325:62–65

    Article  PubMed  CAS  Google Scholar 

  74. Thacher TD, Fischer PR, Isichei CO et al (2006) Early response to vitamin D(2) in children with calcium deficiency rickets. J Pediatr 149:840–844

    Article  PubMed  CAS  Google Scholar 

  75. Knudson AG Jr (1977) Mutation and cancer in man. Cancer 39(Suppl):1882–1886

    Article  PubMed  CAS  Google Scholar 

  76. Arnold A, Staunton CE, Kim HG et al (1988) Monoclonality and abnormal parathyroid genes in parathyroid adenomas. N Engl J Med 318:658–662

    PubMed  CAS  Google Scholar 

  77. Shan L, Nakamura M, Nakamura Y et al (1997) Comparative analysis of clonality and pathology in primary and secondary hyperparathyroidism. Virchows Arch 430:247–251

    Article  PubMed  CAS  Google Scholar 

  78. Miedlich S, Lamesch P, Mueller A et al (2000) Frequency of somatic MEN 1 gene mutations in monoclonal parathyroid tumors of patients with primary hyperparathyroidism. Eur J Endocrinol 143:47–54

    Article  PubMed  CAS  Google Scholar 

  79. Carling T, Correa P, Hessman O et al (1998) Parathyroid MEN1 gene mutations in relation to clinical characteristics of nonfamilial primary hyperparathyroidism. J Clin Endocrinol Metab 83:2960–2963

    Article  PubMed  CAS  Google Scholar 

  80. Akerstrom G, Rudberg C, Grimelius L et al (1986) Histologic parathyroid abnormalities in autopsy series. Hum Pathol 17:520–527

    Article  PubMed  CAS  Google Scholar 

  81. Khosla S, Ebeling PR, Firek AF et al (1993) Calcium infusion suggests a “set-point “abnormality of parathyroid gland function in familial benign hypercalcemia and more complex disturbances in primary hyperparathyroidism. J Clin Endocrinol Metab 76:715–720

    Article  PubMed  CAS  Google Scholar 

  82. Farnebo F, Enberg U, Grimelius L et al (1997) Tumor-specific decreased expression of calcium sensing receptor messenger ribonucleic acid in sporadic primary hyperparathyroidism. J Clin Endocrinol Metab 82:3481–3486

    Article  PubMed  CAS  Google Scholar 

  83. Corbetta S, Mantovani G, Lania A et al (2000) Calcium-sensing receptor expression and signaling in human parathyroid adenomas and primary hyperplasia. Clin Endocrinol (Oxf) 52:339–348

    Article  CAS  Google Scholar 

  84. Brown EM, Pollak M, Hebert SC (1998) The extracellular calcium-sensing receptor: its role in health and disease. Annu Rev Med 49:15–29

    Article  PubMed  CAS  Google Scholar 

  85. Ho C, Conner DA, Pollak MR et al (1995) A mouse model of human familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Nature Genet 11:389–394

    Article  PubMed  CAS  Google Scholar 

  86. Kifor O, Moore FD Jr, Wang P et al (1996) Reduced immunostaining for the extracellular Ca2+-sensing receptor in primary and uremic secondary hyperparathyroidism. J Clin Endocrinol Metab 81:1598–1606

    Article  PubMed  CAS  Google Scholar 

  87. Gogusev J, Duchambon P, Hory B et al (1997) Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int 51:328–336

    Article  PubMed  CAS  Google Scholar 

  88. Inagaki C, Dousseau M, Pacher N et al (1998) Structural analysis of gene marker loci on chromosomes 10 and 11 in primary and secondary uraemic hyperparathyroidism. Nephrol Dial Transplant 13:350–357

    PubMed  CAS  Google Scholar 

  89. Wada M, Nagano N, Furuya Y et al (1997) The calcimimetic compound NPS R-568 suppresses parathyroid cell proliferation in rats with renal insufficiency, control of parathyroid cell growth via a calcium receptor. J Clin Invest 100:2977–2983

    Article  PubMed  CAS  Google Scholar 

  90. Yano S, Sugimoto T, Tsukamoto T et al (2003) Decrease in vitamin D receptor and calcium-sensing receptor in highly proliferative parathyroid adenomas. Eur J Endocrinol 148:403–411

    Article  PubMed  CAS  Google Scholar 

  91. Brown AJ, Zhong M, Finch J et al (1996) Rat calcium-sensing receptor is regulated by vitamin D but not by calcium. Am J Physiol 270:F454–F460

    PubMed  CAS  Google Scholar 

  92. Pradeep PV, Mishra A, Agarwal G et al (2008) Long-term out come after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency. World J Surg 32:829–835

    Article  PubMed  CAS  Google Scholar 

  93. Harinarayan CV, Gupta N, Kochupillai N (1995) Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol (Oxf) 43:351–358

    Article  CAS  Google Scholar 

  94. Priya G, Jyotsna VP, Gupta N et al (2008) Clinical and laboratory profile of primary hyperparathyroidism in India. Postgrad Med J 84:34–39

    Article  PubMed  CAS  Google Scholar 

  95. Özbey N, Erbil Y, Ademoğlu E et al (2006) Correlations between vitamin D status and biochemical/clinical and pathological parameters in primary hyperparathyroidism. World J Surg 30:321–326

    Article  PubMed  Google Scholar 

  96. Raef H, Ingemansson S, Sobhi S et al (2004) The effect of vitamin D status on the severity of bone disease and on the other features of primary hyperparathyroidism (pHPT) in a vitamin D deficient region. J Endocrinol Invest 27:807–812

    PubMed  CAS  Google Scholar 

  97. Banderia F, Griz L, Caldas G et al (2006) From mild to severe primary hyperparathoidism: the Brazilian experience. Arq Bras Endocrinol Metab 50:657–663

    Google Scholar 

  98. Beyer TD, Solorzano CC, Prinz RA et al (2007) Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism. Surgery 141:777–783

    Article  PubMed  Google Scholar 

  99. Ahuja MM (1974) Some aspects of metabolic bone disease as seen in northern India (Delhi area). In: Rastogi GK (ed) Proceedings of the fifth Asian and Oceania congress of endocrinology, Chandigrah, vol 2, pp 201–220

  100. Kapur MM, Agarwal MS, Gupta A et al (1985) Clinical and biochemical features of primary hyperparathyroidism. Indian J Med Res 81:607–612

    PubMed  CAS  Google Scholar 

  101. Sridhar CB, Krishna RR, Sunder AS et al (1973) Primary hyperparathyroidism: a clinical, biochemical and radiological profile with emphasis to geographical variation. Australas Radiol 17:199–204

    Article  PubMed  CAS  Google Scholar 

  102. Lominitz E, Sepulveda L, Stevenson C et al (1966) Primary hyperparathyroidism simulating rickets. J Clin Endocrinol 26:309–313

    Article  Google Scholar 

  103. Rapaport D, Ziv Y, Rubin M et al (1986) Primary hyperparathyroidism in children. J Pediatr Surg 21:395–397

    Article  PubMed  CAS  Google Scholar 

  104. Gloth FM III, Lindsay JM, Zelesnick IB et al (1991) Can vitamin D deficiency produce an unusual pain syndrome. Arch Intern Med 151:1662–1664

    Article  PubMed  Google Scholar 

  105. Malabanan AO, Turner AK, Holick MF (1998) Severe generalized bone pain and osteoporsis in a premenopausal black female; effect of vitamin D replacement. J Clin Densitom 1:201–204

    Article  Google Scholar 

  106. Simpson RU, Thomas GA, Arnold AJ (1985) Identification of 1,25 dihydroxyvitamin D3 receptors and activities in muscle. J Biol Chem 260:8882–8891

    PubMed  CAS  Google Scholar 

  107. Bischoff HA, Borchers M, Gudat F et al (2001) In situ detection of 1,25 dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 33:19–24

    Article  PubMed  CAS  Google Scholar 

  108. Sorenson OH, Lund B, Saltin B et al (1979) Myopathy in bone loss of ageing: improvement by treatment with 1-alpha-hydroxycholecalciferol and calcium. Clin Sci (Colch) 56:157–161

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, SGPGIMS, Lucknow, 226014, Uttar Pradesh, India

    Amit Agarwal & Ranjith Sukumar

  2. Department of Endocrinology, SGPGIMS, Lucknow, Uttar Pradesh, India

    Sushil Kumar Gupta

Authors
  1. Amit Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sushil Kumar Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ranjith Sukumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amit Agarwal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Agarwal, A., Gupta, S.K. & Sukumar, R. Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency. World J Surg 33, 2303–2313 (2009). https://doi.org/10.1007/s00268-009-0044-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0044-0

Keywords

Search

Navigation