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Resistance to vitamin D treatment as an indication of celiac disease in a patient with primary hypoparathyroidism.

Marcondes JA, Seferian Junior P, Mitteldorf CA - Clinics (Sao Paulo) (2009)

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In addition, renal and thyroid function tests were normal... The patient was placed on a high protein diet and treated with oral calcium gluconate and calcitriol with a stepwise increase in the dosage of up to 1.0 mg/day, with persistence of the paresthesia, Chevostek and Trousseau signs, and maleolar edema and without significant changes in metabolic and nutritional parameters (Figure 1)... Maleolar edema was no longer observed and the Chevostek and Trousseau signs were negative... In addition, the levels of total calcium, ionized calcium, albumin and hemoglobin increased to 8.3 mg/dL, 1.1 mM/L, 4.2 g/dL and 11.3 g/dL, respectively, while the prothrombin time decreased from 25 seconds to 11 seconds... Because the hypocalcemia persisted in the patient, we considered changing the diagnosis to malabsorption syndrome due to the presence of chronic diarrhea, since vitamin D absorption is fat-dependent... Assays for the presence of the endomysial antibody were positive and a subsequent biopsy of duodenal mucosa revealed results that were consistent with gluten-sensitive enteropathy or celiac disease... In some reports, such as one describing a 62-year-old woman, hypoparathyroidism was diagnosed 33 years prior to the diagnosis of celiac disease, while in other reports, such as a report characterizing a 60 year-old man, the diagnosis of hypoparathyroidism was made concomitantly with the diagnosis of celiac disease... In a separate report, a patient with idiopathic autoimmune hypoparathyroidism who developed autoimmune hyperthyroidism (Graves’ disease) was subsequently diagnosed with celiac disease... The malabsorption of l-thyroxine was the only indication of the presence of celiac disease... In fact, a common immunological basis that associated the idiopathic hypothyroidism with the celiac disease was hypothesized in this instance... In yet another report, celiac disease was diagnosed in a patient with hypoparathyroidism in the absence of gastrointestinal symptoms... In conclusion, the possibility of celiac disease should be considered in patients with hypoparathyroidism that seems unduly difficult to treat.

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The effect of a gluten-free diet on the ionized calcium levels in a patient with primary hypoparathyroidism associated with celiac disease
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f1-18-le-0040: The effect of a gluten-free diet on the ionized calcium levels in a patient with primary hypoparathyroidism associated with celiac disease

Mentions: The patient was placed on a high protein diet and treated with oral calcium gluconate and calcitriol with a stepwise increase in the dosage of up to 1.0 mg/day, with persistence of the paresthesia, Chevostek and Trousseau signs, and maleolar edema and without significant changes in metabolic and nutritional parameters (Figure 1). The patient’s serum analysis indicated the presence of immunoglobulin A isotype antibodies against endomysium (1/640). Diagnosis of gluten-sensitive enteropathy or celiac disease was suggested at endoscopy, due to flat mucosa, and confirmed by histological findings in duodenal biopsy, including absent villi, crypt hyperplasia and T-cell lymphocytic infiltration in the epithelium. Eleven days after admitting the patient, she was placed on a gluten-free diet, which rapidly lead to the normalization of her bowel habits and improved her metabolic and nutritional parameters.


Resistance to vitamin D treatment as an indication of celiac disease in a patient with primary hypoparathyroidism.

Marcondes JA, Seferian Junior P, Mitteldorf CA - Clinics (Sao Paulo) (2009)

The effect of a gluten-free diet on the ionized calcium levels in a patient with primary hypoparathyroidism associated with celiac disease
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666465&req=5

f1-18-le-0040: The effect of a gluten-free diet on the ionized calcium levels in a patient with primary hypoparathyroidism associated with celiac disease
Mentions: The patient was placed on a high protein diet and treated with oral calcium gluconate and calcitriol with a stepwise increase in the dosage of up to 1.0 mg/day, with persistence of the paresthesia, Chevostek and Trousseau signs, and maleolar edema and without significant changes in metabolic and nutritional parameters (Figure 1). The patient’s serum analysis indicated the presence of immunoglobulin A isotype antibodies against endomysium (1/640). Diagnosis of gluten-sensitive enteropathy or celiac disease was suggested at endoscopy, due to flat mucosa, and confirmed by histological findings in duodenal biopsy, including absent villi, crypt hyperplasia and T-cell lymphocytic infiltration in the epithelium. Eleven days after admitting the patient, she was placed on a gluten-free diet, which rapidly lead to the normalization of her bowel habits and improved her metabolic and nutritional parameters.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In addition, renal and thyroid function tests were normal... The patient was placed on a high protein diet and treated with oral calcium gluconate and calcitriol with a stepwise increase in the dosage of up to 1.0 mg/day, with persistence of the paresthesia, Chevostek and Trousseau signs, and maleolar edema and without significant changes in metabolic and nutritional parameters (Figure 1)... Maleolar edema was no longer observed and the Chevostek and Trousseau signs were negative... In addition, the levels of total calcium, ionized calcium, albumin and hemoglobin increased to 8.3 mg/dL, 1.1 mM/L, 4.2 g/dL and 11.3 g/dL, respectively, while the prothrombin time decreased from 25 seconds to 11 seconds... Because the hypocalcemia persisted in the patient, we considered changing the diagnosis to malabsorption syndrome due to the presence of chronic diarrhea, since vitamin D absorption is fat-dependent... Assays for the presence of the endomysial antibody were positive and a subsequent biopsy of duodenal mucosa revealed results that were consistent with gluten-sensitive enteropathy or celiac disease... In some reports, such as one describing a 62-year-old woman, hypoparathyroidism was diagnosed 33 years prior to the diagnosis of celiac disease, while in other reports, such as a report characterizing a 60 year-old man, the diagnosis of hypoparathyroidism was made concomitantly with the diagnosis of celiac disease... In a separate report, a patient with idiopathic autoimmune hypoparathyroidism who developed autoimmune hyperthyroidism (Graves’ disease) was subsequently diagnosed with celiac disease... The malabsorption of l-thyroxine was the only indication of the presence of celiac disease... In fact, a common immunological basis that associated the idiopathic hypothyroidism with the celiac disease was hypothesized in this instance... In yet another report, celiac disease was diagnosed in a patient with hypoparathyroidism in the absence of gastrointestinal symptoms... In conclusion, the possibility of celiac disease should be considered in patients with hypoparathyroidism that seems unduly difficult to treat.

Show MeSH
Related in: MedlinePlus