Vitamin D deficiency and frequent urination since childhood for a 62-year-old woman. Do you see a link between those two?

And then the second part of that question, “What would you look for in patients that present with these symptoms and what tests would you order?”

Vitamin D deficiency, I think, is pretty common, so I generally supplement to a vitamin D level of around 50 to 60 ng/mL. I don’t know that you need to do additional testing, just because you want to be sort of cost conscious, and how does it actually change your management, would be the question. I guess you could look at genetics, look at the VDR receptor, single nucleotide polymorphism, see if the patient’s going to be more likely to need ongoing vitamin D supplementation. Remember that if you’re using more than maybe 4,000 IUs of vitamin D3, that you probably also want to include a vitamin K2 supplement of about 180 mcg of vitamin K2.

For frequent urination, you might look at cortisol and sort of hormone balance there. She’s 62, so her sex hormones are going to be pretty low. I’m just thinking about aldosterone, cortisol, is there an issue there? Sometimes we will do testing for chronic inflammatory response syndrome, and again, that’s a slightly more nuanced topic, and we have mixed feelings in our practice in terms of how we approach that. But chronic inflammatory response syndrome markers do include antidiuretic hormone and osmolalities. Those can be helpful, and the markers there also include some of these unusual markers like Matrix metalloproteinase 9, vascular endothelial growth factor, transforming growth factor beta-1, C4A. Again, that gets a little bit more nuanced. If she’s had it since childhood, then you probably don’t need to check for urinary tract infection, but of course frequent urination, the first thing you want to look for is urinary tract infection, even if it’s sort of low-grade chronic, if that could be an issue. But certainly checking ADH, antidiuretic hormone, and osmolality could be a good starting place as well.