Presentation of vitamin D deficiency

Area of Science:

• Pediatrics
• Endocrinology
• Nutritional Science

Background:

• Vitamin D deficiency is a global health concern, leading to rickets and hypocalcaemia.
• Certain ethnic minority groups in the UK are identified as at-risk populations.
• Understanding presentation modes is key for timely diagnosis and intervention.

Purpose of the Study:

• To characterize vitamin D deficiency presentations in London children.
• To identify factors influencing the presentation of vitamin D deficiency.
• To highlight the significance of hypocalcaemia as an under-recognized symptom.

Main Methods:

• Retrospective review of pediatric cases from 1996-2001 across four London hospitals.
• Inclusion criteria: hypocalcaemia or rickets due to vitamin D deficiency (plasma 25-hydroxyvitamin D <25 nmol/l).
• Data analysis focused on clinical presentation, radiological findings, and demographic factors.

Main Results:

• Sixty-five children, predominantly from Black or Asian ethnic backgrounds, were identified.
• 48 children had radiological evidence of rickets; 29 presented with hypocalcaemic symptoms.
• Symptomatic hypocalcaemia occurred in children aged <3 or >10 years; growth velocity correlated with presentation.
• All cases resolved with vitamin D supplementation.

Conclusions:

• Rickets persists as a significant health issue in the UK, especially among at-risk ethnic minorities.
• Symptomatic hypocalcaemia is a critical, often overlooked, presentation of vitamin D deficiency.
• Growth rate is a likely determinant of how vitamin D deficiency presents.
• Unexplained hypocalcaemia in at-risk ethnic groups should be presumed to be vitamin D deficiency until proven otherwise.