Sick parathyroid in patients having cirrhosis of liver with hypovitaminosis D

Abstract

The metabolic bone diseases are frequently reported in cirrhosis ofliver worldover. Cirrhotic patients have amplified risk for osteoporosis andfractures (hepatic osteodystrophy). Pakistan being a proclaimed cirrhoticstate, already has a higher burden of morbidity and mortality with its diversecomplications. The local data on vitamin D deficiency in cirrhotic patients isscanty. Determination and comparison of vitamin D status in cirrhotics versushealthy controls, moreover relate severity of cirrhosis with hypovitaminosis D.Furthermore, results in healthy population may redefine reference ranges forfuture endeavors. Hundred and fifty cirrhotics were compared with age andgender match healthy controls. Plasma 25-hydroxyvitamin D, serum phosphate,fasting serum PTH and alkaline phosphatase were determined and compared. Effectof severity of cirrhosis on hypovitaminosis D was determined. This study showed86.66% deficiency of vitamin D, 8 % insufficiency and 7.33% sufficiency amongcirrhotics. Vitamin D level was 28.9± 9.5 ng/mL in Child turcotte Pugh (CTP) -A, 14.4± 3.5 ng/mL in CTP- B and 6.8± 1.9 ng/ mL in CTP C.  Vitamin D level in cirrhotics when comparedwith healthy controls remained statistically insignificant. Hypovitaminosis Dis inversely related with increasing severity of liver disease.                   The hypovitaminosis D is verycommon in liver cirrhosis. Hypovitaminosis D is indirectly related withincreasing severity of liver disease. Low level of vitamin D in our healthypopulation suggests redefinition of normal reference range. The paradoxicalparathyroid hormone response (functional hypoparathyroidism) contrary tosecondary hyperparathyroidism is observed in cirrhotics