L Agrawal1. 1. Division of Endocrinology & Metabolism, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Abstract
OBJECTIVE: To emphasize the role of history and physical examination in the clinical evaluation of hypocalcemia and to describe a patient with celiac sprue and multiple osteonecrosis, a previously unrecognized association. METHODS: A case report is presented of a 39-year-old man with mild hypocalcemia, diarrhea, and arthralgias, and the appropriate clinical and laboratory assessment for these complaints is outlined. RESULTS: Secondary hyperparathyroidism, celiac sprue, and extensive osteonecrosis were detected by hematologic and radiologic studies. The hematologic variables normalized after institution of a gluten-free diet and calcium supplementation. CONCLUSION: This is the first report of celiac sprue and osteonecrosis in one patient. A possible causal relationship due to secondary hyperparathyroidism is suggested, and alternative explanations are discussed.
OBJECTIVE: To emphasize the role of history and physical examination in the clinical evaluation of hypocalcemia and to describe a patient with celiac sprue and multiple osteonecrosis, a previously unrecognized association. METHODS: A case report is presented of a 39-year-old man with mild hypocalcemia, diarrhea, and arthralgias, and the appropriate clinical and laboratory assessment for these complaints is outlined. RESULTS: Secondary hyperparathyroidism, celiac sprue, and extensive osteonecrosis were detected by hematologic and radiologic studies. The hematologic variables normalized after institution of a gluten-free diet and calcium supplementation. CONCLUSION: This is the first report of celiac sprue and osteonecrosis in one patient. A possible causal relationship due to secondary hyperparathyroidism is suggested, and alternative explanations are discussed.