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$Unique_ID{BRK04313}
$Pretitle{}
$Title{Vitamin B12 Deficiency}
$Subject{Vitamin B12 Deficiency Cobalamin Deficiency Anemia, Pernicious
Burning Mouth Syndrome (Burning Tongue Syndrome; Oral Galvanism; Glossodynia;
Glossopyrosis; Stomatodynia; Stomatopyrosis) }
$Volume{}
$Log{}
Copyright (C) 1988, 1989, 1992 National Organization for Rare Disorders,
Inc.
541:
Vitamin B12 Deficiency
** IMPORTANT **
It is possible the main title of the article (Vitamin B12 Deficiency) is
not the name you expected. Please check the SYNONYMS listing on the next
page to find alternate names and disorder subdivisions covered by this
article.
Synonyms
Cobalamin Deficiency
Information on the following disorders may be found in the Related
Disorders section of this report:
Anemia, Pernicious
Burning Mouth Syndrome (Burning Tongue Syndrome; Oral Galvanism;
Glossodynia; Glossopyrosis; Stomatodynia; Stomatopyrosis)
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Vitamin B12 Deficiency is characterized by an abnormally low level of
this vitamin in the blood. The disorder can be caused by a poor diet,
inadequate absorption or utilization of B12 such as following stomach and
intestinal surgery and increase in certain intestinal organisms. The
deficiency causes changes in the blood and the central nervous system.
Injection of this vitamin usually cures the disorder if the underlying cause
can be corrected.
Symptoms
Symptoms of Vitamin B12 Deficiency usually appear years after absorption of
this vitamin ceases, because the amount of B12 needed by the body is tiny,
and a large amount is usually stored in the liver. In most patients, a low
red blood cell count (anemia) develops gradually and progressively as the
stores of Vitamin B12 in the liver are used up. Patients may not be alerted
to the deficiency because of its slow development. Occasionally the spleen
and liver may become enlarged (hepatosplenomegaly). Patients with this
deficiency may also have various gastrointestinal symptoms such as a lack of
appetite (anorexia), intermittent constipation and diarrhea, and poorly
localized abdominal pain. An inflamed tongue (glossitis), usually described
as "burning of the tongue", may be an early symptom of Vitamin B12
Deficiency. Considerable weight loss is common.
Nervous System:
The nervous system may be involved, even in the absence of anemia. Most
commonly, the nerves outside the brain and spinal cord (peripheral nerves)
are involved. The spinal cord may be involved, beginning with loss of
vibratory sensation in the lower extremities, loss of position sense and loss
of muscle coordination (ataxia). Later, spasticity, exaggerated reflexes,
and upward flexing of the big toe upon stimulating the sole of the foot
(Babinski reflex) follows. Some patients with Vitamin B12 Deficiency also
get irritated easily, have mild depressions, or actual paranoia
(megaloblastic madness). Rarely, yellow-blue color blindness may occur.
Causes
Vitamin B12 Deficiency is caused by decreased absorption of this vitamin. It
is most often due to pernicious anemia which causes the mucous lining of the
stomach to fail to secrete the so-called "intrinsic factor" which is needed
for vitamin B12 absorption. The surgical removal of part or all of the
stomach (gastrectomy), and chronic infection causing wasting of the stomach
may also cause deficient secretion of intrinsic factor. Deficiency of
certain endocrine glands (especially thyroid and adrenal glands) if they are
associated with pernicious anemia, suggest an autoimmune basis for
underdevelopment of stomach mucous membrane. Autoimmune disorders are caused
when the body's natural defenses (antibodies) against invading organisms, for
unknown reasons, attack healthy tissue.
Affected Population
Vitamin B12 Deficiency affects males and females in equal numbers.
Related Disorders
Symptoms of the following disorders can be similar to those of Vitamin B12
Deficiency or may be associated with it. Comparisons may be useful for a
differential diagnosis:
Pernicious Anemia is a disorder resulting from an impaired absorption of
vitamin B-12, a necessary co-factor in the production of red blood cells.
Pernicious Anemia develops slowly because the liver stores enough vitamin B-
12 to last 3 to 5 years. The abnormally low number of red blood cells
(anemia) may produce weakness, easy fatigability, shortness of breath
(dyspnea), an abnormally rapid heart beat (tachypnea) and angina. Possible
gastrointestinal problems are similar to those of Vitamin B-12 Deficiency.
(For more information, choose "Pernicious Anemia as your search term in the
Rare Disease Database.)
Burning Mouth Syndrome (Burning Tongue Syndrome) is characterized by a
burning sensation in the mouth and/or the tongue. There is no obvious
clinical evidence of inflammation, although a Candida albicans infection can
be a cause. The cause of most cases Burning Mouth Syndrome, when it is not
associated with Vitamin B12 Deficiency, is unknown. Many causes have been
suggested by researchers, including allergic reactions to pollen, cereals,
metals and materials used in the manufacture of dentures. Burning Tongue may
be an early symptom of Vitamin B-12 Deficiency. (For more information,
choose "Burning Mouth Syndrome" as your search term.)
Therapies: Standard
Treatment for the anemia of Vitamin B12 Deficiency consists of intramuscular
injections of vitamin B12 until the blood and neurologic abnormalities are
cleared up. Oral iron therapy is prescribed if an iron deficiency is also
diagnosed.
If the underlying mechanism of Vitamin B12 Deficiency is known, this
should be corrected.
Therapies: Investigational
The National Institute of Arthritis, Musculoskeletal and Skin Diseases is
looking for patients with various kinds of Ichthyosis willing to participate
in research aimed at mapping the genes responsible for their disorder.
Interested persons may contact:
Dr. Sherri Bale
National Institute of Arthritis, Musculoskeletal and Skin Diseases
9000 Rockville Pike
Bethesda, MD 20892
(301) 402-2679
This disease entry is based upon medical information available through
January 1992. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Vitamin B12 Deficiency, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
Cobalamin Network
P.O. Box 174
Thetford Center, VT 05075
(802) 785-4029 (after 8:00 p.m. EST)
National Digestive Diseases Information Clearinghouse
Box NDIC
Bethesda, MD 20892
(301) 468-2162
NIH/National Heart, Blood & Lung Institute
Office of Public Inquiries
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-4236
References
INTERNAL MEDICINE, 2nd ed.: Jay H. Stein, et al., eds.; Little, Brown,
1987. Pp. 1039-1040.
ISOTOPE-DILUTION ASSAY FOR URINARY METHYLMALONIC ACID IN THE DIAGNOSIS OF
VITAMIN B12 DEFICIENCY. A PROSPECTIVE CLINICAL EVALUATION: D.B. Matchar, et
al.; Ann Intern Med (May 1987: issue 106(5)). Pp. 707-710.
MEGALOBLASTIC ANAEMIA IN A VEGETARIAN HINDU COMMUNITY: I. Chanarin, et
al.; Lancet (November 23, 1985: issue 2(8465)). Pp. 1168-1172.
PRENATAL VITAMIN B12 THERAPY OF A FETUS WITH METHYLCOBALAMIN DEFICIENCY
(COBALAMIN E DISEASE): D.S. Rosenblatt, et al.; Lancet (May 18, 1985: issue
(8)).
PHYSICIAN RESPONSE TO LOW SERUM COBALAMIN LEVELS: R. Carmel, et al.;
Arch Intern Med (June 1986: 146(6)). Pp. 1161-1165.