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Background: Secondary hyperparathyroidism can present for the first time as myopathy in some patients. Strict vegans are at risk of vitamin D deficiency resulting in secondary hyperparathyroidism. A myopathic presentation may lead to investigations and misdiagnosis of neuromuscular disease, ratherthan a metabolic bone disease.
Methods: We report a young lady presenting with severe progressive limb girdle pattern myopathy, with brisk reflexes and periphral neuropathy. Electrophysiology confirmed the presence of ,yopathy and neuropathy, and labaotorial evaluation revealed vitamin D deficiency and elevated parathormone levels.
Results: She was supplemented with vitamin D, and on follow up was found to have a near complete improvement.
Conclusion: Hence it is imperative to evaluate for vitamin D deficiency in all
susceptible patients, especially with a history of strict vegetarianism.
Chandrasekaran S, et al. Occurrence of disabling myopathy secondary to hypovitaminosis S, Narone. UC.IJRCI. 2013;1(1):CS2
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 2017;57(17):3640–3649.
Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2011;1:340-6.
Rasheed K, Sethi P, Bixby E. Severe vitamin d deficiency induced myopathy associated with rhabydomyolysis. N Am J Med Sci. 2013;5(5):334-336. DOI: 10.4103/1947-2714.112491
Carnevale V, Minisola S, Romagnoli E, D’Erasmo E, Bragoni M, Rosso R. Concurrent improvement of neuromuscular and skeletal involvement following surgery for primary hyperparathyroidism. Journal of Neurology. 1992;239:57.
Staff NP. Windebank AJ. Peripheral neuropathy due to vitamin deficiency, toxins, and medications. Continuum (Minneap Minn), Oct;20(5 Peripheral Nervous System Disorders). 2014;1293-1306.
Brent P. Goodman, diagnostic approach to myeloneuropathy; continuum: Spinal cord, root, and plexus disorders. 2011;17(4).
Turken SA, Cafferty M, Silverberg SJ, De La Cruz L, Cimino C, Lange DJ. Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism. The American Journal of Medicine. 1989;87(5):553–557.
Baczynski R, Massry SG, Magott M, El-Belbessi S, Kohan R, Brantbar N. Effect of parathyroid hormone on energy metabolism of skeletal muscle. Kidney Int. 1985;28:722-7.
Bardin T. Musculoskeletal manifestations of chronic renal failure. Curr Opin Rheumatol. 2003;15:48-54.
Curry OB, Basten JF, Francis MO, Smith R. Calcium uptake by the sarcoplasmic reticulum of muscle from vitamin D deficiency in rabbits. Nature. 1974;249:83-4.