Rickets PDF

RICKETS Dr. Alessandro Cattoni  What is rickets? Defective mineralization of growth cartilage affecting the child in developmental age Phosphorus Calcium Inadequate chondrocyte apoptosis in hypertrophic area...

RICKETS Dr. Alessandro Cattoni  What is rickets? Defective mineralization of growth cartilage affecting the child in developmental age Phosphorus Calcium Inadequate chondrocyte apoptosis in hypertrophic area Hypertrophic and calcific zone => increase in size with typical enlarged appearance of the epiphyses Less calcified matrix due to lack of sufficient substrates  Rickets Deficiency Vitamin D Calcium deficiency deficiency Non-deficiency Congenital forms Acquired forms  Vitamin D Cycle 90% 10% inactivatio n VIT D Adipose tissue 25OHD CYP24, CYP3A4 Catabolism 1,25(OH)2 CYP24, CYP3A4 D  Vitamin D Cycle ANd9GcSgAP515EvL41siqdThJeqKnQGIJE-QMf8dk6XBSkSe0R_zbWAwpv2ARQ PTH ABSORPTION Ca 1,25OH2 EXCRETION P D RESORPTION ANd9GcTYb4ly4gXKzBmGVfkZe9aLxZwPE6XpIkOuXKBVLP0x5AzBJ55KuwFNpcs CALCIUM ABSORPTION Ca e P Clinical presentation Clinical presentation Varus or valgus Knee Rackitic bracelet Bowing of long bones Dental alterations Delay in teething Early caries  Additional clinical Signs seizures with hypocalcemia (especially in children under 6-12 months) marked hypotonia or neuromotor delay (walking), ligamentous laxity poor statural-weight growth  Rickets in adolescents Bilateral knee pain Deformity of the limbs Pain and swelling in the wrists Anserine walking Healthy patient Rickets Increased radiotransparency between bones reduced mineralisation of new bone Imaging: Thacher Score 0 to 10  Laboratory tests Calcium: 1 mmol/L = 4 mg/dl Phosphorus: 1 mmol/L = 3 mg/dl Parathyroid hormone: different techniques used (different normal values depending on laboratory) Alkaline phosphatase Urine Creatinine and calcium 25(OH)Vitamin D  Laboratory tests Urinary tests: U-calcium/U-creatine ratio: normal values: