Dr.

Ahmed Alsunni
• A 32 years old lady presented to the clinic
with history of muscle cramps and twitches.
She also complains from tingling sensations in
hands and feet. Tapping at the angle of the
jaw elicited a quick contraction of the facial
muscles of the same side.
• 1,5 year old boy presented to the clinic with
history of failure to thrive and muscle
weakness. Clinical examination showed
bowing of the legs and prominence of
costochondral junctions.
• What is the most likely diagnosis?
• What tests you are going to ask?
 Vitamin D

A steroidlike compound
Considered as a hormone (Why?)
 Activation of vitamin D

It must be activated by adding two

hydroxyl groups
These two reactions occur in the liver
and kidneys
The end result is 1,25-(OH)2 vitamin
D3 or Calcitriol
 Functions of Vitamin D

Vitamin D
increases calcium and phosphate
absorption
in the intestine
 Functions of Vitamin D

Increases the responsiveness of bone

to PTH
(enhance the effect of PTH on bone)
 Functions of Vitamin D

Important for muscle strength

Also important force in energy
metabolism and immune health
Phosphate metabolism

Controlled by the same mechanisms

that regulate calcium metabolism
 Relieves Plasma PO43-
(Because of inverse relationship
between plasma PO43- and Ca2+
concentrations caused by solubility
characteristics of calcium phosphate
salt)
Plasma Ca2+ Kidneys

Parathyroid glands Activated vitamin D

PTH

PO43- reabsorption Ca2+ reabsorption

by kidneys by kidneys

Urinary excretion Ca2+ absorption

of Ca2+ in intestine
(Counteract each other)

Urinary excretion PO43- absorption

of PO43- No change in plasma Ca2+ in intestine

Plasma PO43-
 Disorder in Ca++
metabolism

Parathyroid
Vitamin D
hormone

↑↑ PTH ↓↓ PTH ↓↓ Vit. D

 Hyperparathyroidism
Hypercalcemia
can occur by excess of PTH secretion.
This reduces the excitability of muscle
and nervous tissue leading to muscle
Weekness and neurologic disorders
(poor memory and depression)

Cardiac disturbances can occur

Other effects are the thinning of bones

and the development of kidney stones

Disease of bones, stones, and abdominal groans

 Hypoparathyroidism

Hyposecretion of PTH leads to

hypocalcemia and hyperphosphatemia.
This causes an increase in
neuromuscular excitability

Symptoms include: Irritability

,muscle cramps, tingling
and pins and needles sensations.

In sever cases death may result from

respiratory failure due to sustained
spasm of respiratory muscles
 Vitamin D deficiency

Results in reduce calcium absorption

by the intestine.
This leads to improper bone
matrix mineralization

Bones become soft and deformed

Known as rickets in children and

osteomalacia in adults