Metabolism and Treatment of Osteomalacia

Gargill, Samuel L.; Gilligan, D. Rourke; Blumgart, Herrman L.

doi:10.1001/archinte.1930.00140120054003

Cited by 14 publications

(4 citation statements)

References 24 publications

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“…This was true even though enough was given to slightly elevate the blood calcium levels. The response here is very different from that seen in Blumgart's case (4) and in the study of Bauer and Marble (17) who showed that vitamine D reduced the fecal calcium excretion dramatically in a patient suffering from steatorrhoea.…”

Section: Methodscontrasting

confidence: 99%

“…As far as is now known, such a high calcium output when elevated in both urine and feces is found only in hyperthyroidism and vitamine D deficiencies (3). A patient with osteomalacia, carefully studied by Gargill, Gilligan, and Blumgart (4), showed an analogous high urinary and fecal calcium excretion, which returned to normal after large doses of vitamine D. It was, therefore, of interest to determine whether hyperthyroid cases, because of the elevated metabolic demand, could be suffering from vitamine D deficiencies due to an increased need for vitamines. The idea gains some support in the work of Plimmer (5) of Cowgill and Klotz (6) and of Himwich, Goldfarb and Cowgill (7), which indicates that the amount of vitamine B required by the organism is determined chiefly by its caloric requirement.…”

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confidence: 99%

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Studies of Calcium and Phosphorus Metabolism. Xx. The High Calcium Excretion in Exophthalmic Goiter Is Not Due to Vitamine D Deficiency

Tibbetts¹,

McLean²,

Aub³

1932

J. Clin. Invest.

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In previous publications of this series (1,2), it has been demonstrated that exophthalmic goiter is associated with a calcium and phosphorus excretion elevated in excess of the increased general metabolism. Several conditions have a high urinary calcium excretion. As far as is now known, such a high calcium output when elevated in both urine and feces is found only in hyperthyroidism and vitamine D deficiencies (3). A patient with osteomalacia, carefully studied by Gargill, Gilligan, and Blumgart (4), showed an analogous high urinary and fecal calcium excretion, which returned to normal after large doses of vitamine D. It was, therefore, of interest to determine whether hyperthyroid cases, because of the elevated metabolic demand, could be suffering from vitamine D deficiencies due to an increased need for vitamines. The idea gains some support in the work of Plimmer (5) of Cowgill and Klotz (6) and of Himwich, Goldfarb and Cowgill (7), which indicates that the amount of vitamine B required by the organism is determined chiefly by its caloric requirement. In hyperthyroidism the publications of McCarrison (8) have directed attention to the relation of diet and hyperthyroidism, and Rabinowitch (9) and Fraser and Cameron (10) have published observations which suggested that the addition of vitamines A and D to iodine gave a somewhat greater improvement in Grave's disease, than did iodine alone. In the following observations, this problem was studied by giving irradiated ergosterol to hyperthyroid patients who were maintained on an otherwise constant regime. METHODSThe same careful metabolic routine fully described in previous publications (11), was followed. Further descriptions of this technic need not be added here. The diet was essentially neutral in its acid-base contents as calculated from Sherman's tables (12). The constituents were similar to those of Table VII in paper XI of this series (13), though the total amounts were increased to conform with the caloric needs of 1273

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Section: Methodscontrasting

confidence: 99%

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confidence: 99%

Studies of Calcium and Phosphorus Metabolism. Xx. The High Calcium Excretion in Exophthalmic Goiter Is Not Due to Vitamine D Deficiency

Tibbetts¹,

McLean²,

Aub³

1932

J. Clin. Invest.

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“…Shohl, \Vakeman, and Shorr (37), studying the effect of parathormone on infantile tetany, produced in one of two cases a fall in serum phosphorus from 9.3 to 3.1 with no corresponding rise in serum calcium. Our metabolic criteria of hyperparathyroidism, namely a high urinary P excretion in the presenice of a low serum P, were present in the patient with osteomalacia studied by Gargill, Gilligan, and Blumgart (38) and in the four patients witl osteomalacia studied by MA'iles and Feng (39).…”

Section: B Secondary Hyperparathyroidismmentioning

confidence: 81%

Studies in Parathyroid Physiology

Albright¹,

Bauer²,

Claflin³

et al. 1932

J. Clin. Invest.

134

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In the second paper of this series (1) the disorders of calcium phosphate metabolism were divided into three fundamental groups. It was believed that under normal conditions body fluids contain all the calcium phosphate which that particular fluid system can hold at that particular time. The first and commonest group was that in which the body fluids contain less than this saturating amount of calcium phosphate. Because of this, calcium phosphate is not deposited into osteoid tissue with the resulting pathological picture of wide osteoid seams on the trabeculae (cf. rickets and osteomalacia). The second group was that in which the body fluids, because of certain extraordinary circumstances, contain more than the normal quota of calcium phosphate and deposition in tissues other than osteoid tissue results (e.g. ergosterol poisoning and cases of metastatic malignancy and myeloma). Finally, a third possibility presented itself. It is conceivable that the body fluids might contain a normal saturating amount of calcium phosphate, but that the proportion of the calcium ions to the phosphate ions might be abnormal. Such, it was believed, is the disorder in diseases of the parathyroid glands. To recapitulate then, we conceived of three possible variations from the normal saturation of body fluids with calcium phosphate: (a) subsaturation, (b) supersaturation, and (c) anomalous-saturation (i.e. quantitatively normally but qualitatively abnormally saturated).In the first paper of this series (2), the hypothesis was advanced that this abnormality in the relation of the calcium ion to the phosphate ion in parathyroid disorders was dependent upon changes in phosphorus excretion in the urine brought about by the parathyroid hormone. Thus it was believed that on administration of the parathyroid hormone the first effect was an increased phosphorus excretion; that this resulted in a decreased serum inorganic phosphorus; that this tended to leave the serum's capacity to take up calcium phosphate unfulfilled; that calcium

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“…Plummer & Dunlap [1928] and Aub, Bauer, Heath & Ropes [1929] confirmed that in exoph¬ thalmic goitre of longer duration the continued calcium loss was apparent in X-ray pictures of the bones. Golden & Abbott [1933] in a radiographie study of 110 cases of thyrotoxicosis found 78% were normal, 11% showed slight décalcification and 11% showed definite décalcification. In 51 cases of hypothyroidism similarly studied they found 73% were normal, 18% showed slight décalcification and 9% definite décalcification.…”

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confidence: 98%