Treating vitamin D insufficiency in primary hyperparathyroidism: a cautionary tale.

Abstract

Vitamin D deficiency is a poorly recognized pandemic and can be associated with primary hyperparathyroidism, which is not infrequently found in the general population. No formal guidelines exist to guide therapy for suboptimal Vitamin D status in patients with hyperparathyroidism. However, there are many potential benefits to achieving a Vitamin D replete state before parathyroid surgery. Previous reports have indicated that Vitamin D status can be improved without adverse effects in hyperparathyroidism. We report accentuation of hypercalcemia and hypercalciuria with Vitamin D treatment (weekly 50,000 IU ergocalciferol x 8 weeks) in a 64-year-old Caucasian male veteran with primary hyperparathyroidism, osteoporosis and Vitamin D insufficiency. The exacerbation of hypercalcemia and hypercalciuria resolved with cessation of Vitamin D therapy. We propose that clinicians consider using modest doses of Vitamin D such as 1,000 IU daily for replacement in patients with hyperparathyroidism and Vitamin D deficiency. We recommend that serum and urine calcium be monitored if such treatment is implemented.

• Authors: Warit Jithpratuck, Linda H Garrett, Alan N Peiris
• Journal: Tennessee medicine : journal of the Tennessee Medical Association (Tenn Med) Vol. 104 Issue 7 Pg. 47-9 (Aug 2011) ISSN: 1088-6222 [Print] United States
• PMID: 21932692 (Publication Type: Case Reports, Journal Article)

Chemical References

• Vitamin D

Topics

• Humans
• Hypercalcemia (etiology)
• Hypercalciuria (etiology)
• Hyperparathyroidism (complications, metabolism)
• Male
• Middle Aged
• Vitamin D (adverse effects, therapeutic use)
• Vitamin D Deficiency (complications, drug therapy)