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Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

¹ Division of Endocrinology, Department of Medicine, Roger Williams Medical Center, 825 Chalkstone Avenue, Providence, Rhode Island 02908-4728, USA² Boston University School of Medicine, Boston, Massachusetts, USA³ The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

(Correspondence should be addressed to J R Tucci; Email: umgtucci{at}yahoo.com)

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 D₂ 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.