MON-735 A Case Of Vitamin D Deficiency Resistant To Treatment: A Diagnostic Challenge
Abstract
Abstract Disclosure: A. Bassatne: None. S. Tobolsky: None. A.O. Malabanan: None. Background: Vitamin D deficiency is prevalent worldwide due to inadequate sun exposure, limited dietary sources, and malabsorption disorders. Deficiency is associated with impaired calcium homeostasis, osteoporosis, increased fracture risk, and muscle weakness, as well as a higher susceptibility to infections, autoimmune and cardiovascular diseases. Therefore, management through supplementation, dietary intake, and ultraviolet B (UVB) exposure is essential. Clinical Case: A 55-year-old female patient with history of ovarian tumor s/p hysterectomy and oophorectomy at age 38 presented to clinic for management of vitamin D deficiency and osteoporosis. She reports long lasting body aches and myalgias. On evaluation, she was found to have undetectable 25(OH)D levels (20 ng/ml). Other labs were significant for elevated PTH levels 242 pg/ml (Ref: 11-90 pg/ml) as well as elevated Alkaline Phosphatase (168 U/L; Ref 25-100 U/L). Her calcium and phosphorus levels were normal. DXA scan revealed osteoporosis at the femoral neck (T-score -4.5) and total hip (T-score -3.8). She was trialed on different doses of ergocalciferol (D2) and cholecalciferol (D3) up to 50,000 IU/day in addition to improving UVB exposure with tanning beds and UVB lamps. However, her 25(OH)D levels did not respond and remained suboptimal. As part of a research study, she had an absorption test which revealed undetectable D2 levels after…
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