Haddad, John G.

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Henry Ford Hospital Medical Journal Volume 31 Number 4 Article 17 12-1983 Calcium Disorders in Childhood John G. Haddad Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal  Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Haddad, John G. (1983) "Calcium Disorders in Childhood," Henry Ford Hospital Medical Journal : Vol. 31 : No. 4 , 231-232. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol31/iss4/17 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Henry Ford Hosp Med J Vol 31, No 4,1983 Calcium Disorders in Childhood John G. Haddad, MD* fd. Note - This overview was originally presented at the International Symposium on Clinical Disorders of Bone and Mineral Metabolism, May 9-13,1983. The following list indicates the presentations given in this session at the Symposium and the contents ofthe corresponding chap-ter in the Proceedings of the Symposium published by Excerpta Medica. The numbers in parentheses refer to pages in this volume. Complete information about the contents ofthe Proceedings can be found at the back of this issue. Neonatal disorders of mineral homeostasis. C.S. Anast (422) Neonatal osteopenia - Diagnosis and management. L.S. Hil lman (427). Familial hypocalciuric hypercalcemia: Implications and questions from a broad spectrum of clinical features. S.J. Marx, A .M . Spiegel, R.W. Downs jr, R.D. Lasker, and A.C. Santora Jr (432) Diagnosis and management of hypophosphatemic dis-orders. F.H. Glorieux (438) Hereditary hypocalcemic vitamin D resistant rickets (HHDR). U.A. Liberman, C. Eil, and S.J. Marx (441) The general focus of this session was to highlight the time of life when development, rapid growth, and skel-etal modeling occur. Interest in mineral homeostasis dur ing this period of development has grown as expo-nentially as the rate of bone growth itself, but time con-straints permitted only a representative sampling of work in the field. Organ development and growth are intimately l inked with the ontogenesis of hormone bio-synthesis, transport and response machinery. Since neo-natologists are now able to save very premature infants, a whole new group of infants must make the transition from the placental guarantee of minerals in utero to the postnatal uncertainty of diets, infusions, and environments. The placental transfer of calcium to the fetus provides a 20-30 g calcium content to the ful l- term infant. Calcium, magnesium and inorganic phosphorus concentrations are higher in fetal than in maternal blood in many species, including humans. Although a close correlation between maternal and neonatal vitamin D "nu t r i t i on " has been observed by many investigators, no evidence for placental crossover of parathyroid hormone has been presented (1). Depending on a variety of factors in utero and postna-tally, the infant's adjustment to an independent mineral and skeletal homeostasis can be smooth and fairly rapid, or it can be troubled and protracted (2,3). Anast (pp. 422 ff.) provided a concise review of recent studies dealing with normal and abnormal neonatal mineral homeostasis. Early and late neonatal hypocalcemia appear to be attributable to different mechanisms, since parathyroid responses differ, but at present, clear under-standing of their pathogenesis is lacking. Neonatal hypercalcemic syndromes are described as well as recent experience with an infant whose study revealed features of both primary hyperparathyroidism and familial hypo-calciuric hypercalcemia. Both Anast and Marx and colleagues (pp. 431 ff.) addressed the issue of hypercalcemia in infancy and the impor-tance of extending observations to renal handling of calcium and studies of family members. Although the basic defect(s) are not characterized in familial hypocal-ciuric hypercalcemia, clinical studies now available instruct us to be vigilant about this diagnosis. •Depar tment of Med i c i ne , University of Pennsylvania School of Med ic ine , Philadelphia Address repr int requests to Dr. Haddad, Department of Med ic ine , University of Pennsylvania, 531 Johnson Pavil ion, 36th and Hami l lon Walk, Philadelphia, PA 19104, 231 Haddad Hillman (pp. 427 ff.) discussed some important areas to be considered in assessing the difficulties of mineral and skeletal homeostasis during the neonatal period. The availability of minerals and sterols must be taken into account, and the issues of their appropriateness for infants represents a great challenge to investigators. The recent application of minerally-enriched formulae to the diet of premature infants appears to be an improve-ment over past practice. Optimal vitamin D supplemen-tation awaits def ini t ion in small premature infants, and the frequency of mult iple problems contr ibuting to their osteopenia is worth our notice. Although firmly entrenched in the literature, the concept of vi tamin-D resistance is currently being reevaluated with newly available methodology. Glorieux (pp. 438 ff.) and Liberman et al (pp. 441 ff.) discussed new findings and therapeutic approaches in this area. With the recen tiy available techniques in assay of hormones, receptors, hormone effects and histomorphometry, a more rational classification of apparent vitamin D resist-ance seems likely. Conversely, improved understanding of human diseases of vitamin D metabolism and action should provide clues to, and probes for, unraveling the mechanisms of vitamin D bioactivity. References 1. Tsang RC, Steichen JJ, Chan G M , Chen IW, Whitsett JA, Erenberg AE, Donovan EF, Brown DR. In: DeLuca HF, Anast CS, eds. Pediatric diseases related to calcium. North Hol land: Elsevier, 1980:323-44. 2. Hi l lman LS, Haddad JG. In: DeLuca HF, Anast CS, eds. Pediatric diseases related to calcium. North Hol land: Elsevier, 1980:355-66. 3. Hi l lman LS, Haddad JG. In; Heath DA, Marx SJ, eds. Clinical endo-cr ino logy 2-calc ium disorders. But terwor ths Int M e d Revs, pp 248-76. 232 

Calcium Disorders in Childhood

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Calcium Disorders in Childhood

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