Resistance to Vitamin D Treatment as an Indication of Celiac Disease in a Patient with Primary Hypoparathyroidism

Hypocalcemia may present as an asymptomatic laboratory finding or as a severe, life-threatening condition. Upon the diagnosis of acute hypocalcemia, a rapid treatment regimen may be necessary. In contrast, chronic hypocalcemia may be well tolerated by the patient, but treatment nonetheless remains necessary in order to prevent long-term complications. The hallmark of acute hypocalcemia is neuromuscular irritability, although paresthesias of the extremities may also occur, along with fatigue and anxiety. In addition, very painful muscle cramps may develop and can progress into carpal spasms or tetany. From a clinical perspective, neuromuscular irritability can be demonstrated by testing for Chevostek or Trousseau signs. However, all of these symptoms can be corrected by the administration of calcium replacement treatments. The observation of an inappropriately normal PTH coupled with hypocalcemia should promptly warrant the diagnosis of hypoparathyroidism, which may be transient, genetically inherited, or acquired due to an autoimmune process. It may also follow surgery or neck irradiation treatment. In this paper, we present a case study of a patient with primary hypoparathyroidism who is surprisingly resistant to the usual treatment consisting of calcium and vitamin D supplementation. The coincident observation of chronic diarrhea prompted us to consider the possibility of a malabsorption syndrome with steatorrhea, since vitamin D absorption is fat-dependent.