The Relationship between Calcium-Phosphorus Metabolism, the `Krebs Cycle' and Steroid Metabolism

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Abstract
A new approach to the mechanism regulating Ca/ P metabolism and the process of ossification has been suggested. In classical and vitamin D resistant rickets as well as in the "de Toni-Debre-Fanconi syndrome" evidence has been found of a disturbance of citric acid metabolism and of the suprarenal steroids; the same disturbances have been shown in a case of tetany with hyperadrenocorticism: such biochemical disturbances are probably related to one another. It seems possible that an alteration in the "Krebs cycle" operating in the renal tubules plays an important part. In one case of "de Toni-Debre-Fanconi syndrome" and in 2 cases of rickets, which did not respond to the usual treatment with vitamin D2, the renal threshold for citric acid was lowered ("renal citrate diabetes"). These findings suggest the possibility of a unified pathogenesis for the various disturbances of Ca/P metabolism.