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1/10. Brown tumour as a complication of secondary hyperparathyroidism in severe long-lasting vitamin d deficiency rickets.

    Brown tumour is a localised form of fibrous-cystic osteitis associated with primary or secondary hyperparathyroidism. Despite the fact that secondary hyperparathyroidism occurs in vitamin d deficiency rickets, no cases of rickets with brown tumour have so far been described. We present a 2.9-year-old girl who had brown tumour of the mandible due to severe vitamin d deficiency rickets. Treatment with vitamin D3 corrected the hyperparathyroidism rapidly which was followed by gradual regression in tumour size. CONCLUSION: Brown tumour can develop in severe, long-standing vitamin d deficiency rickets and responds to vitamin D treatment.
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keywords = rickets
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2/10. Secondary hyperparathyroidism as a palpable intrathyroid parathyroid gland in a patient with hypophosphatemic osteomalacia.

    Secondary hyperparathyroidism is sometimes seen in patients with hypophosphatemic osteomalacia after long-term oral phosphate therapy. parathyroidectomy is sometimes needed for the correction of hypercalcemia in these patients, and is rarely performed in patients without hypercalcemia. A 46-year-old female patient had hypophosphatemic osteomalacia with unknown cause and secondary hyperparathyroidism. A palpable neck mass developed after long-term oral phosphate therapy. An intrathyroid parathyroid gland was confirmed through partial thyroidectomy and parathyroidectomy. Renal phosphate wasting decreased strongly, and serum parathyroid hormone was in the normal range after the operation. A correction of secondary hyperparathyroidism may partially overcome hyperphosphaturia in some patients with hypophosphatemic rickets.
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ranking = 13.088265520806
keywords = hypophosphatemic rickets, hypophosphatemic, rickets
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3/10. Transient neonatal hyperparathyroidism: a presenting feature of mucolipidosis type II.

    The phenotype of mucolipidosis type II (ML II), a disorder of lysosomal enzyme transport, includes mucopolysaccharidosis type I (Hurler syndrome)-like features and dysostosis multiplex, usually apparent after 6 months of age. We describe here the natural history of neonatal hyperparathyroidism, a recently described presentation of ML II. A female neonate presented with multiple fractures and radiological features of osteopenia and 'rickets-like' changes. Longitudinal evaluation, while the patient was treated with vitamin D 800-3,000 IU/day orally, indicated secondary hyperparathyroidism which resolved, biochemically and radiologically, by age 4 months. Neonatal hyperparathyroidism in ML II is severe, transient, and probably secondary to impaired placental calcium transport, simulating a condition observed in the offspring of chronically hypocalcemic mothers.
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ranking = 0.125
keywords = rickets
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4/10. Vitamin-D-dependent rickets type II. Resistance of target organs to 1,25-dihydroxyvitamin D.

    Studies were done to determine the cause for hypocalcemia, secondary hyperparathyroidism, osteomalacia and osteitis fibrosa cystica in a 22-year-old black woman. The patient had normal serum 25-hydroxyvitamin D (14 ng per milliliter) and markedly elevated serum 1,25-dihydroxyvitamin D (137 pg per milliliter). Vitamin D3, 4000 units per day for four weeks, increased the serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D to as high as 29 and 297 pg per milliliter, respectively, and corrected the hypocalcemia and secondary hyperparathyroidism. The results suggest that the disorder results from impaired end-organ response to 1,25-dihydroxyvitamin D. We propose that the entity be called vitamin-D-dependent rickets Type II.
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ranking = 0.625
keywords = rickets
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5/10. Congenital hyperparathyroidism and rickets: secondary to maternal hypoparathyroidism and vitamin d deficiency.

    A case of severe secondary hyperparathyroidism and congenital rickets in a preterm infant is described. Extensive demineralization of the bones and deformation of the rib cage caused fatal respiratory distress. The severity of the case is attributed to the combination of idiopathic hypoparathyroidism and nutritional vitamin d deficiency in the mother.
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ranking = 0.625
keywords = rickets
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6/10. Vitamin D dependent rickets: decreased sensitivity to 1,25-dihydroxyvitamin D.

    A patient with vitamin D dependent rickets with decreased sensitivity to 1,25-Dihydroxyvitamin D was observed. She suffered from bone pain of two years duration beginning at 12 years of age and was found to be suffering from hypocalcemia, secondary hyperparathyroidism and osteomalacia. Laboratory findings revealed normal serum 25-hydroxyvitamin D (27 ng/ml) and markedly elevated serum 1,25-dihydroxy-vitamin D (131.9 pg/ml). The hypocalcemia was refractory in spite of administration of 25,000 units of vitamin D2, but therapy with high doses of oral la-hydroxyvitamin D3 resulted in significant elevation of the serum calcium level. The clinical findings and course of the patient's disease were quite different from those of other patients with vitamin D dependent rickets reported by other authors.
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ranking = 0.75
keywords = rickets
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7/10. Bilateral slipping of the upper femoral epiphysis in end-stage renal failure. A report of two cases.

    Two cases of bilateral slipping of the upper femoral epiphysis in boys with end-stage renal failure due to megacystis and mega-ureter with severe renal osteodystrophy are reported. In one patient the lesion emerged after a dystonic reaction to drugs and in the other after bilateral nephro-ureterectomy. Neither showed marked elevation of growth hormone levels, but both had evidence of renal rickets with severe secondary hyperparathyroidism. Both had a satisfactory response to bilateral internal fixation. The complication should be borne in mind in all young patients with renal osteodystrophy.
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ranking = 0.125
keywords = rickets
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8/10. Unusual cases of hyperparathyroidism.

    The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets.
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ranking = 3.7612753468788
keywords = hypophosphatemic rickets, hypophosphatemic, rickets
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9/10. Congenital rickets. Study of the evolution of secondary hyperparathyroidism.

    A case of congenital rickets of nutritional origin is described in a light-for-date premature infant (gestational age 34 weeks, birthweight 1 100 g). x-rays of the long bones showed spread, frayed and cupped metaphyses at birth and at the age of 16 days. serum calcium was 8.2 mg/100 ml, phosphorus 3.4 mg/100 ml and alkaline phosphatase (A.P):323 IU/ml (N less than or equal to 200) at the age of 3 days. Very high level of serum immunoreactive parathroid hormone (iPTH) was found at the age of 16 days=295 micronlEq/ml (N less than or equal to 50). Evidence of maternal vitamin d deficiency was demostrated by low plasma 25-hydroxycholecalciferol (25-OH-CC):1.0 ng/ml (N:13.2 /-4.2) soon after delivery; it was found to be normal (10.2 ng/ml) six months later. Ca infusion (15 mg/kg/3 h) resulted in a marked fall of serum iPTH (280 to 84 micronlEq/ml). Administration of vitamin D2 (2400 IU/day for 10 days) induced some healing of the metaphyses; A. P. remained elevated (400 IU/ml); plasma 25-OH-CC was normal 10.2 ng/ml and serum iPTH was 115 micronlEq/ml. When 25-OH-CC was given orally for ten days (15 microng/day), plasma 25-OH-CC rose to 64.5 ng/ml with a minor change of serum iPTH (94 micronlEq/ml); x-rays of the bones showed osteoporosis. These results suggest a reduced convertion of 25-OH-CC into 1-25-(OH)2-CC.
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ranking = 0.625
keywords = rickets
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10/10. Hypophosphatemic rickets with sacroiliitis-like presentation in an adolescent.

    rickets can manifest with a wide variety of rheumatic symptoms. In this paper, a fifteen year old female patient with hypophosphatemic rickets presenting with symptoms suggesting sacroiliitis at disease onset is reported. The sacroiliac joint involvement in this case was attributed to the subchondral bone fractures due to the secondary hyperparathyroidism. Her symptoms resolved completely after treatment with calcitriol and phosphate solution for hypophosphatemic rickets.
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ranking = 8.0225506937576
keywords = hypophosphatemic rickets, hypophosphatemic, rickets
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