Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

Eur J Endocrinol. 2009 Jul;161(1):189-93. doi: 10.1530/EJE-08-0901. Epub 2009 Apr 21.

Abstract

Objective: To determine whether vitamin D repletion of patients with primary hyperparathyroidism (PHPT) and vitamin D deficiency or insufficiency (hypovitaminosis D) has deleterious clinical and/or biochemical effects.

Design: Prospective audit of the effect of vitamin D repletion on biochemical data in 56 patients with PHPT. Patients were treated with 50,000 units of vitamin D2 weekly for 8 weeks with biochemical measurements at 5 and 10 weeks, and subsequently after 12 weeks on 800 units of vitamin D3 daily, and in those with hypovitaminosis D after 12 weeks of up to 100 000 units of vitamin D(2) monthly.

Methods: Serum calcium, albumin, phosphorus, 25-OHD, intact parathyroid hormone (PTH) and urine calcium/creatinine (Ca/Cr) ratios were measured before and during vitamin D therapy.

Results: Patients treated with 50,000 units of vitamin D2 weekly for 8 weeks resulted in a significant increase in serum 25-OHD levels from 36.4 to 89.4 nmol/l at 5 weeks (P<0.0001) and 88.6 nmol/l at 10 weeks (P<0.0001). There were no significant changes in serum calcium. At 10 weeks, there was a non-significant decrease in serum PTH and in urine Ca/Cr ratios. None of the patients developed any calcium-related adverse events. Subsequently, patients with subnormal 25-OHD levels on 800 units of vitamin D daily were treated for the next 12 weeks with up to 100,000 units of vitamin D2 monthly with normalization of serum 25-OHD in all but 4 patients.

Conclusion: These data fail to demonstrate any adverse effects of vitamin D repletion in PHPT.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Calcium / blood
  • Calcium / urine
  • Creatine / urine
  • Female
  • Humans
  • Hyperparathyroidism, Primary / complications
  • Hyperparathyroidism, Primary / drug therapy*
  • Male
  • Medical Audit
  • Middle Aged
  • Parathyroid Hormone / blood
  • Phosphorus / blood
  • Prospective Studies
  • Vitamin D / administration & dosage*
  • Vitamin D / adverse effects
  • Vitamin D / blood
  • Vitamin D Deficiency / complications
  • Vitamin D Deficiency / drug therapy*
  • Vitamins / administration & dosage*
  • Vitamins / adverse effects
  • Vitamins / blood

Substances

  • Parathyroid Hormone
  • Vitamins
  • Vitamin D
  • Phosphorus
  • Creatine
  • Calcium