Vitamin D-Deficient Rickets in an Adolescent: A Clinical Case

Wed, 05 Apr 2023 18:00:02 +0300

⛅VITAMIN D-DEFICIENT RICKETS IN AN ADOLESCENT MISDIAGNOSED AS JUVENILE RHEUMATOID ARTHRITIS. A CLINICAL CASE. 🚶‍♂ANAMNESIS. From the age of 13, the patient complained of joint pain and morning stiffness. He received treatment for juvenile rheumatoid arthritis, without effect. Over two years, his growth velocity decreased from 18.6 cm/year to 4.5 cm/year, and genu valgum deformity of the lower limbs developed. Family history of short stature was burdened: mother’s height 155 cm, father’s 153 cm, target height 160.5 cm (-2.14 SD). Resides in the Far North. At 15.9 years of age, severe growth retardation was diagnosed (150.2 cm -2.87 SD). Endocrine genesis of short stature was excluded. 🧪LABORATORY DATA Based on a sharply reduced vitamin D level (<4.00 ng/ml), secondary elevation of parathyroid hormone (105.9 pg/ml), normal calcium (1.1 mmol/l) and phosphorus (0.99 mmol/l) levels in the blood, elevated alkaline phosphatase (768 U/l), a decrease in the maximum tubular reabsorption of phosphates to GFR (TmP/GFR) to 0.9, tubular reabsorption of phosphates (%TRP) 91.1% (normal), and a rickets severity index (RSS) of 4.25 points, the diagnosis was established: “Vitamin D-deficient rickets.” 💊TREATMENT In the hospital, therapy with cholecalciferol at a dose of 4000 IU/day was initiated, against which normalization of PTH level (24.34 pg/ml) and a decrease in calcium excretion (Ca in urine 0.62 mmol/l) were noted. ‼CONCLUSIONS Short stature combined with limb deformities developed during a period of intense growth should serve as a reason to exclude rickets-like diseases. Prevention and timely diagnosis of rickets in adolescents can prevent the development of disabling complications of the disease and irreversible skeletal deformities. 👉Source: RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS, 2020; 65:(4)

Vitamin D on Leukoformula

Vitamin D-Deficient Rickets in an Adolescent: A Clinical Case