Roentgenologic Manifestations of Vitamin D Intoxication

Abstract

The roentgenographic appearance of certain lesions associated with the prolonged and excessive use of vitamin D preparations of high potency has been referred to in many previous publications (1–4) and has been described in detail in an excellent review of the subject by Christensen, Liebman, and Sosman (5). The changes usually described include abnormal periarticular deposits of calcareous material and the absorption of bone, which is usually referred to in the roentgenologic literature as generalized osteoporosis. Because these lesions have been discovered in a relatively small number of patients who have ingested vitamin D in massive doses, the present study was undertaken to determine, if possible, what other pathologic or physiologic factors may contribute to their production. Material Studied A review was made of the clinical records and of all the available roentgenograms of 56 patients in whom a diagnosis of vitamin D intoxication was made at the Mayo Clinic. The clinical diagnosis in each instance was based on a history of ingestion of huge amounts of potent vitamin D preparations for prolonged periods, the development of the symptoms of vitamin D intoxication following use of the drug, and the disappearance of these toxic manifestations after its withdrawal in those cases in which subsequent follow-up information was available. The patients of this series experienced the symptoms of vitamin D intoxication which have been described in many previous publications (4, 6–15). Those associated with the gastrointestinal tract included anorexia, nausea, vomiting, pain in the abdomen, epigastric distress, diarrhea, loss of weight, and the sensation of an unusual taste in the mouth. Symptoms referable to the urinary tract were frequency, nocturia, polyuria, polydipsia, and urgency. There were also symptoms referable to the central nervous system, such as headache, drowsiness, dizziness, and haziness of memory. Pruritus was also of frequent occurrence. All available laboratory data were tabulated in each case. Those referable to the chemical constituents of the blood included the concentrations of calcium, phosphorus, urea, creatinine, uric acid, sulfate, serum protein, and acid and alkaline phosphatases. Other examinations of the blood included erythrocyte and leukocyte counts, determinations of the concentration of hemoglobin, and the erythrocyte sedimentation rate. Urine had been tested for specific gravity, reaction, relative concentration of albumin, and the presence of erythrocytes and leukocytes. In some instances the amounts of calcium and phosphorus excreted during twenty-four hours were measured. The Sulkowitch test had been applied to the urine in some instances.