Secondary Deficiency

This may develop in conditions associated with diarrhoea, cirrhosis or malabsorption, as well as after extensive postoperative use of parenteral nutrition lacking adequate niacin. Pellagra may occur during prolonged isoniazid therapy (the drug replaces niacinamide in NAD), in malignant carcinoid tumour (tryptophan is diverted to form 5-hydroxytryptamine), and in Hartnup disease, an autosomal recessive disorder in which there is defective conversion of tryptophan to niacin (Beers & Berkow 2003). It has also been observed in Crohn's disease, most likely due to malnutrition and intestinal malabsorption (Abu-Qurshin et al 1997).

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