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Refractory Vitamin D Deficiency — RACP Adult Medicine MCQ

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ModerateEndocrinologyRefractory Vitamin D DeficiencyRACP Adult Medicine

A 35-year-old woman with coeliac disease has persistent vitamin D deficiency (25-OH-D 18 nmol/L) despite oral cholecalciferol 5000 IU daily for 6 months. She is adherent to a gluten-free diet but continues to have villous atrophy on follow-up biopsy. What is the most appropriate next step?

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Correct answer: E — Ergocalciferol 50000 IU weekly for 8 weeks

Persistent vitamin D deficiency despite adequate oral supplementation in coeliac disease with ongoing malabsorption (villous atrophy) may require high-dose intermittent oral loading (ergocalciferol/cholecalciferol 50000 IU weekly), IM vitamin D injections (if oral fails), or UV-B phototherapy. Assess GFD adherence and consider refractory coeliac disease if villous atrophy persists despite strict GFD. Among options, high-dose ergocalciferol loading is the most appropriate escalation.

Reference: GESA – 2024 – Coeliac Disease; eTG Endocrine 2024