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R. Sivapackianathan, A. Parker, R. Carpenter, P. Achan, A. Rastogi, J. Sarkodieh, W.M. Drake, Profound vitamin D deficiency in coeliac disease and pregnancy, QJM: An International Journal of Medicine, Volume 108, Issue 4, April 2015, Pages 345–346, https://doi.org/10.1093/qjmed/hcu205
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Case presentation
A 23-year-old Turkish woman with known coeliac disease presented to hospital with a fractured left femur (Figure 1 a) sustained when arising from bed. Two years prior, she sustained a fracture at the right humerus (Figure 1 b), caused by lifting the younger of her two children. Hypercalcemia was documented at the time of the first fracture, but she defaulted from follow-up.
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Investigation on admission for the femoral fracture revealed iron-deficiency anaemia and undetectable vitamin D levels (in keeping with suspected non-compliance with a gluten-free diet). Her serum calcium was 2.93 mmol/l (normal range [NR] 2.2–2.6) with a serum parathyroid hormone level (PTH) of 29.6 pmol/l (NR 1.1–6.9) and a urine calcium excretion of 10.9 mmol in 24 hrs (NR 2.5–7.5), diagnostic of primary hyperparathyroidism. In addition to her displaced left femoral fracture, extensive lytic deposits were seen throughout the skeleton with one in the left tibia, thought to be at imminent risk of fracture. Ultrasound of the neck was suggestive of a left lower parathyroid adenoma.
