Table 1: Summary of observed disease stages, the
corresponding key events, expected markers, presumed pathophysiology and
distinct clinical diagnoses of chronic fatiguing illnesses.
Stage |
Corresponding key
stage events |
Expected markers |
Presumed pathophysiologic
changes |
Correlated
clinical diagnosis |
I |
Lack of sunlight. Low calcium diet. |
25OHD3 low. |
Calcium and/or phosphate deficiency, Phosphate toxicity due to high phosphate diet. |
Idiopathic fatigue |
II |
Calcium body stores low, but serum Ca2+ and Pi normal
due to accelerated bone loss. |
1,25(OH2D3) high, though 25(OH)D3 low.
|
FGF23 low due to low calcium x phosphate product and due to low 25OHD3?
αKL low due to low 25OHD3? CaSR activity variable due to bone loss and diet. |
Chronic fatigue syndrome |
III |
Calcium body stores very low. |
PTHi inappropriate to serum and urine Ca2+?
|
αKL very low? |
Vitamin D3-resistant chronic fatigue syndrome |
IV |
Ca x Pi body stores extremely low. |
Obviously elevated Pi/Crea and Ca2+/Crea ratio?
Unsuspected laboratory results? Truncated FGF23 and PTH? |
Tubular epithelial damage with multi-mineral depletion? Reduced renal NH4+excretion?? |
Myalgic encephalopathy (younger patients). Fibromyalgia (older patients). Somatic irreversible secondary diseases. |
Abbreviations: 25OHD3:
25-hydroxyvitamin D3, 1,25(OH)2D3: 1,25-dihydroxyvitamin
D3, αKl: α-Klotho, Ca2+: calcium, CaSR: Calcium sensing receptor, FGF23: Fibroblast Growth
Factor-23, Pi: Phosphate, PTHi: Parathormone intact