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Various factors, including poor nutritional status and other compounding factors such as dietary, cultural, ethnic, and environmental factors, play a major role in contributing to the poor calcium and vitamin D homeostasis. Vitamin D deficiency is thought to exacerbate signs and symptoms of hyperparathyroidism (HPT). In this overview, we present evidence of the impact of vitamin D and calcium deficiency on primary HPT (PHPT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed an evidence\u2010based review of articles published in the English language between January 1960 and June 2008.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Level IV evidence suggests widespread calcium and vitamin D deficiency in developing countries (issue 1). Limited level IV evidence suggests malnutrition as a primary cause of calcium and vitamin D deficiency (issue 2). Level IV evidence suggests that calcium and vitamin deficiencies cause secondary HPT and possibly PHPT as well (issues 3 and 4). A literature search revealed only six studies that correlated vitamin D levels with clinical, biochemical, and pathologic features of PHPT (issue 5). These studies provide level IV evidence suggesting that vitamin D deficiency causes some specific clinical features of PHPT as well as exacerbating other features of the disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the developing countries, which have severe vitamin D and calcium deficient population, PHPT patients present with advanced disease and particularly severe bone symptoms. There is presently only level IV evidence of vitamin D status affecting the clinical severity of PHPT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-009-0044-0","type":"journal-article","created":{"date-parts":[[2009,4,28]],"date-time":"2009-04-28T13:09:44Z","timestamp":1240924184000},"page":"2303-2313","source":"Crossref","is-referenced-by-count":22,"title":["Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency"],"prefix":"10.1002","volume":"33","author":[{"given":"Amit","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Endocrine Surgery SGPGIMS 226014 Lucknow Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil Kumar","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Endocrinology SGPGIMS Lucknow Uttar Pradesh 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