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Parathyroid hormone and calcitonin levels in vitamin D deficient rickets
Insights
Infants with vitamin D deficient rickets show abnormal calcium (Ca) and phosphorus (P) levels, with high parathyroid hormone (PTH) and calcitonin (CT). Calcium infusion normalized some levels and altered hormone excretion.
Area of Science:
- Pediatric Endocrinology
- Nutritional Rickets
- Mineral Metabolism
Background:
- Vitamin D deficient rickets in infants disrupts calcium and phosphorus homeostasis.
- Hormonal imbalances, including parathyroid hormone (PTH) and calcitonin (CT), are characteristic of this condition.
- Understanding these metabolic derangements is crucial for effective treatment.
Purpose of the Study:
- To investigate the blood levels and urinary excretion of key minerals and hormones in infants with vitamin D deficient rickets.
- To assess the impact of calcium (Ca) infusion on these parameters.
Main Methods:
- Studied six infants (5-8 months) with vitamin D deficient rickets.
- Measured serum Ca, P, alkaline phosphatase, PTH, and CT.
- Analyzed urinary excretion of Ca, P, hydroxyproline, and cyclic AMP.
- Administered a 4-hour infusion of calcium gluconate.
Main Results:
- Basal conditions showed high alkaline phosphatase, PTH, and CT. Hypocalcemia or hypophosphatemia was present in all infants.
- Low urinary Ca excretion and high urinary P, hydroxyproline, and cyclic AMP were observed.
- Calcium infusion increased serum Ca and CT, while decreasing alkaline phosphatase and PTH.
- Post-infusion, CT levels decreased, and phosphaturia, hydroxyprolinuria, and cyclic AMP excretion reduced.
Conclusions:
- Infants with vitamin D deficient rickets exhibit significant mineral and hormonal dysregulation.
- Calcium infusion can modulate these parameters, suggesting a role in managing the condition.
- Further research is needed to elucidate the long-term effects and optimal therapeutic strategies.
Abstract:
In six infants aged between 5 and 8 months with vitamin D deficient rickets, we have studied blood levels of calcium (Ca), phosphorus (P), alkaline phosphatase, immunoreactive parathyroid hormone (PTH) and calcitonin (CT), as well as urinary excretion of Ca, P, hydroxyproline and cyclic AMP, both under basal conditions and during a 4h infusion of 20 mg/kg 10% Ca gluconate in normal saline. Under basal conditions all the infants had high alkaline phosphatase (range: 470--770 U.I./1); PTH (range: 620--1200 pg Eq/ml) and CT (range: 440--750 pg/ml) but two infants had hypocalcaemia and four had normocalcaemia and hypophosphataemia. The urinary Ca excretion was low whereas the urinary P, hydroxyproline and cyclic AMP excretions were high. During Ca infusion the total serum Ca and CT levels increased, while alkaline phosphatase and PTH fell. After the end of the infusion, CT levels fell perceptibly; phosphaturia, hydroxyprolinuria and cyclic AMP decreased on the day of the infusion.