Sick parathyroid in patients having cirrhosis of liver with hypovitaminosis D

The metabolic bone diseases are frequently reported in cirrhosis of liver worldover. Cirrhotic patients have amplified risk for osteoporosis and fractures (hepatic osteodystrophy). Pakistan being a proclaimed cirrhotic state, already has a higher burden of morbidity and mortality with its diverse complications. The local data on vitamin D deficiency in cirrhotic patients is scanty. Determination and comparison of vitamin D status in cirrhotics versus healthy controls, moreover relate severity of cirrhosis with hypovitaminosis D. Furthermore, results in healthy population may redefine reference ranges for future endeavors. Hundred and fifty cirrhotics were compared with age and gender match healthy controls. Plasma 25-hydroxyvitamin D, serum phosphate, fasting serum PTH and alkaline phosphatase were determined and compared. Effect of severity of cirrhosis on hypovitaminosis D was determined. This study showed 86.66% deficiency of vitamin D, 8 % insufficiency and 7.33% sufficiency among cirrhotics. 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 compared with healthy controls remained statistically insignificant. Hypovitaminosis D is inversely related with increasing severity of liver disease. The hypovitaminosis D is very common in liver cirrhosis. Hypovitaminosis D is indirectly related with increasing severity of liver disease. Low level of vitamin D in our healthy population suggests redefinition of normal reference range. The paradoxical parathyroid hormone response (functional hypoparathyroidism) contrary to secondary hyperparathyroidism is observed in cirrhotics with hypovitaminosis D.