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Osteomalacia after prolonged glutethimide administration.

R H Greenwood, F T Prunty, J Silver

    British Medical Journal
    |March 17, 1973
    PubMed
    Summary
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    Long-term use of glutethimide, a hypnotic drug, can cause vitamin D deficiency and osteomalacia by increasing the metabolism of vitamin D. These effects are reversible upon drug discontinuation.

    Area of Science:

    • Pharmacology
    • Endocrinology
    • Hepatology

    Background:

    • Vitamin D deficiency is a growing health concern.
    • Hypnotic medications are widely prescribed.
    • Potential drug-induced complications require thorough investigation.

    Purpose of the Study:

    • To report a novel complication of hypnotic therapy: vitamin D deficiency.
    • To investigate the association between glutethimide and osteomalacia.
    • To elucidate the metabolic mechanisms underlying this adverse effect.

    Main Methods:

    • Case report of a patient with osteomalacia.
    • Analysis of vitamin D metabolism markers.
    • Assessment of liver enzyme induction.
    • Monitoring of drug discontinuation effects.

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    Main Results:

    • The patient presented with osteomalacia linked to long-term glutethimide use.
    • Glutethimide induced hepatic enzymes, accelerating vitamin D metabolism.
    • Elevated liver enzymes (gamma-glutamyl transpeptidase, 5-nucleotidase, leucine aminopeptidase) and xylulose excretion were observed.
    • Discontinuation of glutethimide led to reversal of these biochemical abnormalities.

    Conclusions:

    • Glutethimide is associated with vitamin D deficiency and osteomalacia.
    • Hepatic enzyme induction by glutethimide plays a key role in vitamin D catabolism.
    • This case highlights the importance of monitoring vitamin D status in patients on long-term hypnotic therapy.