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Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study

¹ Aarhus Bone and Mineral Research Group, Departments of Endocrinology and ² Metabolism C, ³ Clinical Biochemistry, Histopathology and⁴ Surgical Department L, Aarhus University Hospital, Tage-Hansensgade 2, DK 8000 Aarhus C, Denmark

(Correspondence should be addressed B Moosgaard, Email: bmoos{at}as.aaa.dk)

Background: Primary hyperparathyroidism (PHPT) is associated with reduced plasma 25-hydroxyvitamin D (P-25OHD) and usually increased plasma 1,25-dihydroxyvitamin D (P-1,25(OH)₂D). Parathyroid tissue expresses the vitamin D receptor and it is thought that circulating 1,25(OH)₂D participate in the regulation of parathyroid cell proliferation, differentiation and secretion.

Aim: To investigate the relations between circulating levels of 1,25(OH)₂D and 25OHD respectively and parathyroid adenoma weight (AW), plasma-parathyroid hormone (P-PTH) and PTH secretion expressed as P-PTH/AW.

Design: Cross-sectional study.

Material: One hundred and seventy-one consecutive hypercalcaemic caucasian patients aged 19–87 years (median 63, 84% females) with surgically proven parathyroid adenoma.

Results: A weak positive correlation was found between P-25OHD and P-1,25(OH)₂D (r = 0.24, P < 0.005). AW depended on sex and body mass index. Following adjustment, it was correlated positively to P-PTH, calcium (Ca) and alkaline phosphatase (AP) and inversely to plasma phosphate in a multiple regression model. AW was not associated with vitamin D metabolites. Preoperative P-PTH correlated positively to plasma levels of Ca and AP, but inversely to phosphate and 25OHD (P < 0.001) levels. P-PTH was not associated with P-1,25(OH)₂D (P = 0.65). The P-PTH:AW ratio correlated inversely to P-25OHD (P < 0.05), but showed no relations to plasma levels of Ca, phosphate or 1,25(OH)₂D (P = 0.22).

Conclusion: In this material, low levels of 25OHD were related to higher levels of P-PTH and higher PTH:AW ratios in patients with PHPT suggesting that vitamin D deficiency increase PTH secretion activity. Neither PTH secretion nor AW was associated with circulating levels of 1,25(OH)₂D.