During the period of 10 years, we recorded 78 cases of hypocalcemia amongst individuals less than the age of 21 years. Of these, 3 cases had late neonatal hypocalcemia and two were diagnosed to have rickets due to vitamin D deficiency. Both had radiological features consistent with the diagnosis and a nutri- tional cause was identified (late weaning, impoverished household). Interestingly both children were below the age of 1 year and presented with seizures. We did not have any patient identified as hypoparathyroidism (HP) nor did we encounter any one with pseudohypoparathyroidism (PHP). Although we have cases attending our endocrinology clinics that carry these diagnoses and have been biochemically characterized.

In order to capture and analyze the true prevalence/incidence, institutions must have a protocol in place that tracks patients particularly children who present with hypocalcemia. It would provide a windfall of information on syndromic hypocalcemia related to aberrations in caclitropic hormone biology which in turn could provide vital genetic information on populations served. We are contemplating a prospective study with end points defined to get a better idea of hypocalcemia in our pediatric population.

While looking carefully at the above referred paper, we were struck by the absence of data on vitamin D (25:1:25 dihydroxy-vitamin D3) and I-PTH. Since patients have been labeled as PHP and VDDR; these data need to be provided to the readers. We are sure that these measurements must have been obtained since diagnosis would be impossible otherwise. Clinical scores alone would not suffice.

Romesh Khardori,
Romasia Firdose,
Division of Endocrinology, Metablism and Molecular Medicine,
Department of Internal Medicine,
Southern Illinois University School of Medicine,
701 N First Street; D-404B,
Springfield IL 62794-9636, USA
E-mail: [email protected]