CHRONIC VITAMIN-A INTOXICATION WITH MUSCU LOSKELETAL SYMPTOMS AND MORPHOLOGIC HEPATIC ALTERATIONS - DESCRIPTION OF A CASE

The case of a 69-year-old woman with a chronic vitamin A intoxication syndrome after self-administration of vitamin A is presented. The clin ical picture included musculoskeletal disorders, headache and hepatome galy. The diagnosis of chronic vitamin A intoxication was based on a h istory of excessive vitamin A ingestion, clinical chemistry and needle biopsy of the liver. Besides retinol and retinylester, the serum conc entration of retinol-binding protein (RBP) should be determined. Where as the serum retinol concentration in chronic vitamin A intoxication o ften does not correlate with toxicity, the ratio between retinol and R BP and the concentration of retinylester is more sensitive. Morphologi cal alterations are associated with the cumulative dosage of ingested vitamin A, whereas the daily amount of vitamin A determines the latenc y until pathological changes occur. The hormone-like, retinoid-recepto r mediated molecular mechanism of action seems to be responsible for t he multisystemic manifestations in chronic vitamin A intoxication synd rome.