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Hypophosphatemic Rickets and Hyperparathyroidism
Hypophosphataemic Rickets and Hyperparathyroidism

Presentation

Leading experts from Latin America, Africa, Near and Middle East, Indian Subcontinent, Far East, Oceania and Australia present their expert insights into specific conditions, as well as progress and challenges in the development of the specialty. [books.google.com]

Rickets of the spine or pelvis, dental enamel defects, and tetany that occur in dietary vitamin D deficiency are rarely present in hypophosphatemic rickets. Patients with HHRH may present with nephrolithiasis and/or nephrocalcinosis. [msdmanuals.com]

PRESENTATION AND CLINICAL FEATURES Hypocalcaemia may be an incidental finding, or it can result in symptoms such as paraesthesia or cramps. [adc.bmj.com]

The patient presented retarded growth and diverse malformations. Laboratory studies disclosed the presence of hypo phosphatemia with normal calcium levels and elevated phos phatases. [elsevier.es]

Rickets and/or osteomalacia is the presenting feature. Mild forms may present with hypercalciuria and nephrolithiasis without bone disease. [boneandspine.com]

Entire Body System

  • Weakness

    – This occurs in major muscles, but also may manifest as: diplopia, low cardiac output, dysphagia, and respiratory depression due to respiratory muscle weakness. [en.wikipedia.org]

    Signs Proximal muscle weakness, diaphragmatic weakness. Laboratory findings: hypophosphatemia (low serum phosphorus 18 years of age; refer to gender and age specific lower limits of normal in patients < 18 years of age). [endocrinologyadvisor.com]

    Oncogenic osteomalacia is a paraneoplastic syndrome of osteomalacia, hypophosphataemia, renal phosphate loss, bone pain, and muscle weakness. [patient.info]

    Snapshot A 6-year-old boy is brought to his pediatrician by his parents due to poor growth, weakness, and abnormal gait. On physical exam, there is bowing of the legs and tenderness upon palpation of the lower extremity. [medbullets.com]

    Muscle weakness and hypotonia are absent. Etiology The disease is caused by various mutations in the PHEX gene (Xp22.1) and is transmitted as an X-linked dominant trait with complete penetrance, but variable expressivity. [orpha.net]

  • Short Stature

    stature Skeletal: rickets bone pain Chest Ribs Sternum Clavicles And Scapulae: rachitic rosary Skeletal Limbs: bowing of lower extremities Endocrine Features: parathyroid hyperplasia, benign [malacards.org]

    An outstanding feature of familial hypophosphatemic rickets is disproportionate short stature. Adults show osteomalacic changes and calcification of entheses and joint capsules. [boneandspine.com]

    Such crystals, on migration to the papilla get precipitated as stones. [6] Complications An outstanding feature of familial hypophosphatemic rickets is short stature. [6, 7] The short stature associated with this condition is disproportionate, resulting [emedicine.medscape.com]

    stature, bowing of lower limbs (esp at knees causing genu varum ) & rachitic changes in the long bones; - ht at initial dx is usually - coxa vara is also common in untreated patients; - in some affected patients, the disorder is manifested only by a [wheelessonline.com]

  • Falling

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    Theoretically, postprandial hyperphosphatemia may act directly on the parathyroid gland or may induce a fall in ionized calcium, and by this induce hyperparathyroidism [ 4 ]. [pubs.sciepub.com]

    Serum PTH concentrations were reduced by 51 percent after acute therapy with the highest dose of the calcimimetic and there was a slight fall in serum calcium concentrations. [enotes.tripod.com]

  • Fatigue

    Asymptomatic hypercalcemia detected by routine biochemical screening Symptomatic hypercalcemia During evaluation for manifestations of hyperparathyroidism such as osteopenia, osteoporosis, bone pain, or nephrolithiasis, PUD, constipation, N/V, pancreatitis, fatigue [enotes.tripod.com]

    Physical findings of fatigue, myalgia, and weakness may accompany bony deformities. Genu valgum (knock knees) may occur as well as the more typical genu varum (bow legged) appearance. [adc.bmj.com]

    Presentation Chronic or mild hypophosphataemia may be asymptomatic (phosphate levels 0.6-0.8 mmol/L). [ 1 ] Most patients with hypophosphataemia have no specific symptoms or perhaps fatigue. [patient.info]

    Attempts to reduce phosphorus supplementation failed because of muscle cramps and fatigue at lower doses. [jmedicalcasereports.biomedcentral.com]

  • Fever

    This includes most common respiratory alkalemia (a higher than normal blood pH from low carbon dioxide levels in the blood), which in turn is caused by any hyperventilation (such as may result from sepsis, fever, pain, anxiety, drug withdrawal, and many [en.wikipedia.org]

    A 6-month-old white girl presented with a 2-day history of fever and respiratory symptoms. Initially, she was admitted with a diagnosis of respiratory syncytial virus bronchiolitis. [consultant360.com]

Gastrointestinal

  • Vomiting

    Other clinical problems included severe abdominal pain, nausea, vomiting, peptic ulcer, and pancreatitis. [enotes.tripod.com]

    Malnutrition due to malabsorption or persistent vomiting. The severely ill patient is most at risk when they start to recover and move from a catabolic state to an anabolic state. Vitamin D deficiency. [patient.info]

  • Failure to Thrive

    Case 2 A white boy with a history of extrahepatic BA (Kasai hepatoportoenterostomy at 2 months of age) presented at 6 months of age with persistent jaundice, progressive hepatosplenomegaly, portal hypertension, failure to thrive, and significant hypophosphatemia [pediatrics.aappublications.org]

Skin

  • Dermatitis

    Guidelines (Manganese) - canadaca Know More Gross deficiencies of manganese have never been observed in the general population, but a recent experimental study involving human subjects fed a manganese-deficient diet (011 mg/d) resulted in the development of dermatitis [cdabodegraven-reeuwijk.nl]

Ears

  • Hearing Impairment

    In some affected individuals, hearing impairment due to malformation of the inner ears (sensorineural hearing loss) may also be present. [rarediseases.org]

Musculoskeletal

  • Osteoporosis

    NEPHROLITHIASIS/OSTEOPOROSIS, HYPOPHOSPHATEMIC, 1 Gene Set From CTD Gene-Disease Associations genes/proteins associated with the disease NEPHROLITHIASIS/OSTEOPOROSIS, HYPOPHOSPHATEMIC, 1 from the curated CTD Gene-Disease Associations dataset. [amp.pharm.mssm.edu]

    Updated clinical guidelines for diabetes, lipid disorders, obesity management, osteoporosis, and more, as well as essential treatment updates for the medical management of acromegaly, Cushing's Disease, hypercalcemia, and diabetes mellitus. [books.google.com]

    Treatment with antiresorptive agents may be indicated in patients with osteopenia or osteoporosis. [enotes.tripod.com]

    Paget disease of bone Multiple myeloma Laboratory Abnormalities in Select Bone Disorders Etiology Serum Phosphate Serum Calcium Serum Alkaline Phosphatase Parathyroid Hormone Osteoporosis Normal Normal or decreased Normal Normal Paget disease of the [medbullets.com]

    The radiological examination revealed osteoporosis, osteomalacia and evidence of rickets involving the metaphyses. [elsevier.es]

Psychiatrical

  • Fear

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Workup

(See Etiology and Workup.) In XLH patients, the severe hypophosphatemia (< 2.5 mg/dL) is associated with elevated serum alkaline phosphatase. [emedicine.medscape.com]

The patient's 18-month-old sister had a history of delayed gross motor milestones and also had frontal bossing; however, a workup had never been done, nor had the child been treated. [consultant360.com]

Serum

  • Phosphate Decreased

    Review Topic QID: 2930 1 Low serum phosphate, elevated alkaline phosphatase, elevated PTH 2 Low serum phosphate, elevated alkaline phosphatase, normal PTH 3 Low serum phosphate, elevated alkaline phosphatase, decreased PTH 4 Elevated serum phosphate, [orthobullets.com]

Treatment

See also the following treatment articles: Treatments for Rickets Treatments for Hyperparathyroidism Causes See also causal information: Causes of Hypophosphatemic rickets Causes of Hypophosphatemia Causes of Rickets Causes of Hyperparathyroidism Similar [familydiagnosis.com]

Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]

The patient, while under treatment with alphacalcidol and oral phosphate, developed hypercalciuria, nephrocalcinosis, secondary hyperparathyroidism and arterial hypertension. [scienceopen.com]

“Treatment of severe hypophosphatemia”. Ann Intern Med. vol. 89. 1978. pp. 941-4. (An excellent overview of hypophosphatemia and its treatment.) Clark, CL, Sacks, GS, Dickerson, RN, Kudsk, KA, Brown, RO. [endocrinologyadvisor.com]

Prognosis

Prognosis With consistent treatment, prognosis is good and skeletal deformities can be normalized, but growth rates usually remain subnormal. The documents contained in this web site are presented for information purposes only. [orpha.net]

Prognosis of Hypoph0sphatemic Rickets Apart from the short stature of most affected adults, the prognosis for a normal lifespan and normal health is good. Abnormal dentine formation causes late dentition and spontaneous abscess formation. [boneandspine.com]

[…] alkaline phosphatase (TNSALP) gene mutation that leads to the accumulation of pyrophosphate pyrophosphate inhibits bone mineralization Pathogenesis impaired mineralization of osteoid (osteomalacia) and/or cartilage at the epiphyseal plates (rickets) Prognosis [medbullets.com]

Concomitant use of calcitriol dampens this effect. 24 Prognosis Affected persons have a normal life span. With early diagnosis and good compliance with therapy, deformities can be minimized. [consultant360.com]

Prognosis Correction of acute hypophosphataemia tends to leave no long-term complications but failure to recognise and treat an acute, severe situation can lead to fatality. [patient.info]

Etiology

[…] inflammatory bowel disease and gastrointestinal bypass surgery genetic causes that result in vitamin D deficiency and vitamin D resistance primary hypophosphatemia e.g., X-linked hypophosphatemic rickets and autosomal dominant hypophosphatemic rickets Etiology [medbullets.com]

(See Etiology and Treatment.) [emedicine.medscape.com]

Etiology The disease is caused by various mutations in the PHEX gene (Xp22.1) and is transmitted as an X-linked dominant trait with complete penetrance, but variable expressivity. [orpha.net]

(A discussion of the etiology and diagnostic approach to tumor induced osteomalacia.) Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved. [endocrinologyadvisor.com]

[…] this question is for PEAK Premium Subscribers only Sorry, this question is for PEAK Premium Subscribers only Sorry, this question is for PEAK Premium Subscribers only (OBQ13.38) Low serum phosphate and normal calcium levels are found in what common etiology [orthobullets.com]

Epidemiology

Summary Epidemiology It is the most common form of hereditary hypophosphatemia with a prevalence of approximately 1/ 20,000. The disease affects both sexes equally. [orpha.net]

(Rickets secondary to vitamin D defiency) Introduction Clinical definition osteomalacia a condition due to defective mineralization of osteoid rickets a condition due to defective mineralization of carti lage in the epiphyseal growth plates Epidemiology [medbullets.com]

Epidemiology Hypophosphataemia is rare in the general population but relatively common in hospitalised patients (2.2-3.1%) and higher still in those on intensive care units (28.8-33.9%), those with sepsis (65-80%), those with chronic alcoholism (2.5-30.4% [patient.info]

J Bone Miner Res 4:460–475 Google Scholar Dunnigan MG, Henderson JB (1997) An epidemiological model of privational rickets and osteomalacia. [link.springer.com]

Pathophysiology

This edition has been thoroughly revised by world-renowned contributors to reflect recent developments in renal pathophysiology. [books.google.com]

Positional cloning of the PEX gene: new insights into the pathophysiology of X-linked hypophosphatemic rickets Am J Physiol Renal Physiol. 1997;273:489-498 [malattierare.regione.veneto.it]

Introduction A defect in mineralization of osteoid matrix caused by inadequate calcium and phosphate prior to closure of physis known as rickets after physeal closure called osteomalacia Pathophysiology disruption of calcium/phosphate homeostasis poor [orthobullets.com]

[…] diphosphoglycerate (2,3-DPG) causing a left shift in the oxyhemoglobin curve. [ citation needed ] Other rarer causes include: Certain blood cancers such as lymphoma or leukemia Hereditary causes Liver failure Tumor-induced osteomalacia [ citation needed ] Pathophysiology [en.wikipedia.org]

Prevention

Management and treatment Treatment aims at improving growth, bone or joint pain, and preventing skeletal deformities caused by rickets. Patients do not respond to vitamin D supplementation. [orpha.net]

Succinct, targeted coverage of normal childhood growth and development, as well as the diagnosis, management, and prevention of common pediatric diseases and disorders, make this an ideal medical reference book for students, pediatric residents, nurse [books.google.com]

Prevention. A proper diet that includes vitamin D–fortified milk is usually sufficient to prevent rickets. Ordinary milk contains adequate amounts of calcium but is a poor source of vitamin D. [medical-dictionary.thefreedictionary.com]

Phosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J Clin invest 97: 2534-2540, 1996. [pubs.sciepub.com]

The usual medication regimen must be carefully monitored to prevent excess blood or urinary calcium levels. The approach does not completely cure the disorder. [rarediseases.org]

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