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Endocrine Abstracts (2012) 29 S54.2

ICEECE2012 Symposia Vitamin D (3 abstracts)

Vitamin D and primary hyperparathyroidism

L. Mosekilde 1,


1Aarhus University Hospital, Aarhus C, Denmark; 2University of Aarhus, Aarhus, Denmark.


The occurrence of vitamin D (vitD) insufficiency (plasma 25OHD<50 nmol/l) and deficiency (25OHD<25 nmol/l) in primary hyperparathyroidism (PHPT) varies worldwide in prevalence, severity and symptoms. Epidemiological studies support that the clinical presentation of PHPT is more severe in patients with coexisting vitD deficiency. Most PHPT patients in Europe only have slightly decreased plasma 25OHD levels compared with gender-, age- and season matched controls, and severe symptomatic vitamin D deficiency is rare. However, in the patients low plasma 25OHD appear to be associated with higher levels of PTH, calcium and bone turnover and lower femoral neck and forearm BMD. Low 25OHD has also been associated with higher left ventricular mass index.

The decrease in plasma 25OHD in PHPT has been explained by i) a stimulated renal 1α-hydroxylation of 25OHD to 1,25(OH)2D induced by PTH and hypophosphatemia, ii) an increased 24-hydroxylase activity with hydroxylation of 25OHD and 1,25(OH)2D to more polar metabolites, iii) increased body weight in PHPT patients, and iv) development of secondary and later tertiary hyperparathyroidism because of long standing severe vitD deficiency.

In cases where the combination of both PHPT and hypovitaminosis D is diagnosed vitamin D repletion is an option. However, only limited evidence exists for this treatment. In case series and cohort studies vitD treatment lowers preoperative PTH levels and may reduce bone turnover in some cases. Furthermore, high vitD status may decrease the risk of postoperative hypocalcaemia and secondary hyperparathyroidism. However, there are no randomised controlled studies to prove any beneficial effects on calcium and bone metabolism or on muscle function, CNS symptoms or quality of life. Furthermore, serum and urinary calcium may increase in some patients. It is unknown, whether routine vitD supplementation should be offered preoperatively to all PHPT patients or as part of long term medical follow-up.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Volume 29

15th International & 14th European Congress of Endocrinology

European Society of Endocrinology 

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