Hypercalcemic hyperparathyroidism and hypophosphatemic osteomalacia complicating neurofibromatosis |
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Authors: | Dr Robert S Weinstein Rodney L Harris |
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Institution: | (1) Metabolic Bone Disease Laboratory, Section of Metabolic and Endocrine Disease, Department of Medicine, Medical College of Georgia, Rm BD-248, 30912 Augusta, Georgia, USA |
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Abstract: | Summary Neurofibromatosis is sometimes complicated by impaired renal tubular reabsorption of phosphate, hypophosphatemia, and osteomalacia.
Hyperparathyroidism has also been reported in patients with neurofibromatosis. When hypercalcemia and elevated levels of parathyroid
hormone are found in osteomalacia, however, it may be difficult to determine if the hyperparathyroidism was primary or tertiary.
We describe a patient with neurofibromatosis, hypercalcemic hyperparathyroidism, hypophosphatemic osteomalacia, vitamin D
deficiency, and clear-cell hyperplasia of all four parathyroid glands. Serial biomechanical, bone biopsy, and densitometric
studies confirmed that treatment with ergocalciferol, calcium, and phosphate supplements significantly improved the osteomalacia
but caused increased parathyroid overactivity. After subtotal parathyroidectomy, the parathyroid hormone concentration became
normal and the bone mineral content increased at the spine and hip, but inappropriate phosphaturia persisted. The findings
indicate that hyperparathyroidism, osteomalacia, and vitamin D deficiency adversely affect each other. |
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Keywords: | Neurofibromatosis Hyperparathyroidism Osteomalacia Hypophosphatemia Vitamin D deficiency |
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