Primary hyperparathyroidism with low serum 1,25-dihydroxyvitamin D levels

The Journal of Clinical Endocrinology and Metabolism
J WortsmanE M Brown

Abstract

Primary hyperparathyroidism is usually associated with normal or elevated serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] levels. We report a patient with extreme hypercalcemia (serum calcium, 19.4 mg/dl), primary hyperparathyroidism, and a very low plasma concentration of 1,25-(OH)2D. Surgical removal of a large parathyroid adenoma was associated with a decrease in the serum calcium and immuno- and bioactive PTH concentrations and normalization of the 1,25-(OH)2D level. The postoperative course was complicated by severe protracted hypocalcemia and cardiac arrest, requiring treatment with large doses of calcium iv. The low concentrations of 1,25-(OH)2D in this patient are an unusual manifestation of primary hyperparathyroidism, probably due to suppression of renal 1 alpha-hydroxylase activity by the severe hypercalcemia. We conclude that in severe hypercalcemia, a low serum 1,25-(OH)2D level does not exclude the diagnosis of primary hyperparathyroidism.

Citations

Apr 3, 2009·Biochemical and Biophysical Research Communications·Kishiko NakajimaKanji Sato
Jan 3, 2008·Clinical Endocrinology·Leif Mosekilde
Mar 20, 2008·Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research·Rana SamadfamDavid Goltzman
Feb 23, 1987·The American Journal of Medicine·T P JacobsC M Gundberg
Dec 1, 1988·The American Journal of the Medical Sciences·N A Breslau

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