Would Vitamin D levels in PRIMARY hyperparathyroidism be low or high?

[AspiringOne]

---

Members do not see this ad.

I always thought they would be high but Goljan says they would be low because of the increased calcium. However, BRS physio says they would be high because the PTH stimulates 1alpha-hydroxylase (which was what I thought). Does anyone know the verdict on this?

I could just imagine one of those questions where the patient has symptoms of primary hyperparathyroidism, narrowing it down to the one with High vs Low Vitamin D, and not knowing what to do 😕

 

[whoknows2012]

I always thought they would be high but Goljan says they would be low because of the increased calcium. However, BRS physio says they would be high because the PTH stimulates 1alpha-hydroxylase (which was what I thought). Does anyone know the verdict on this?

I could just imagine one of those questions where the patient has symptoms of primary hyperparathyroidism, narrowing it down to the one with High vs Low Vitamin D, and not knowing what to do 😕

PTH directly stimulates 1-alpha hydroxylase in the kidney so if there was a question on this I would definitely choose increased Vitamin D

 

[SeekerOfTheTree]

I always thought they would be high but Goljan says they would be low because of the increased calcium. However, BRS physio says they would be high because the PTH stimulates 1alpha-hydroxylase (which was what I thought). Does anyone know the verdict on this?

I could just imagine one of those questions where the patient has symptoms of primary hyperparathyroidism, narrowing it down to the one with High vs Low Vitamin D, and not knowing what to do 😕

I had the same issue with this what you are having. The thing is when you have hypercalcemia that decreases 1 alpha hydroxylase in proximal tubules. That is why you don't get an increased in 1,25 D. If you look at page 496 in RR Goljan you will see it. I would trust this. Incase you are wondering, I memorized all of goljan, page numbers and all. I've been doing that since the start of this year.

If the cause is primary hyperthyroidism with high serum calcium then this should be true I think.

 

[whoknows2012]

I had the same issue with this what you are having. The thing is when you have hypercalcemia that decreases 1 alpha hydroxylase in proximal tubules. That is why you don't get an increased in 1,25 D. If you look at page 496 in RR Goljan you will see it. I would trust this. Incase you are wondering, I memorized all of goljan, page numbers and all. I've been doing that since the start of this year.

If the cause is primary hyperthyroidism with high serum calcium then this should be true I think.

agree mostly but how did the calcium get high in the first place? increased gut absorption and break down of bone etc. So at some point in the disease process, most likely in the beginning, Vitamin D levels have got to be elevated. Later on once there is hypercalcemia I agree Vitamin D levels will be reduced. The only thing is if you look up diagnostic criteria for Primary HPTH it doesn't mention vitamin D levels...so that would make sense if they can vary throughout the disease progression.

 

[SeekerOfTheTree]

agree mostly but how did the calcium get high in the first place? increased gut absorption and break down of bone etc. So at some point in the disease process, most likely in the beginning, Vitamin D levels have got to be elevated. Later on once there is hypercalcemia I agree Vitamin D levels will be reduced. The only thing is if you look up diagnostic criteria for Primary HPTH it doesn't mention vitamin D levels...so that would make sense if they can vary throughout the disease progression.

You're correct. I think your explanation makes the most sense. It must vary based on stage of disease.

 

[CBG23]

I was just about to post this exact same question when I noticed this topic. I looked it up on uptodate and it says that in primary hyperparathyroidism, 1,25 (OH)2 Vit. D is elevated. Harrison's says this as well:

"1,25(OH)2D levels are elevated in many (but not all) patients with primary hyperparathyroidism"

Maybe it's not always the case, but I'm thinking Goljan had it right the first time before his errata changed it to decreased 1,25 (OH)2 Vit. D...

 

[CBG23]

BTW, does alk phos really increase with primary hyperparathyroidism? It was my understanding that it only increased in cases where bone deposition increased, but first aid says alk phos is up...

 

[Step1Hash]

BTW, does alk phos really increase with primary hyperparathyroidism? It was my understanding that it only increased in cases where bone deposition increased, but first aid says alk phos is up...

Alk phos is a measure of Osteoblast activity and since PTH acts on osteoblasts to induce osteoclasts you get increased alk phos.

 

[VisionaryTics]

Supplement Vitamin D in known as the sunlight vitamin because even relatively brief experience sun activates our body to produce its own provide. It is discovered in relatively few meals but a number of meals such as milk products and other milk products items are prepared with the vitamin .

Cool.

 

[Bernoull]

Supplement Vitamin D in known as the sunlight vitamin because even relatively brief experience sun activates our body to produce its own provide. It is discovered in relatively few meals but a number of meals such as milk products and other milk products items are prepared with the vitamin .

😱 amazing stuff! cool story....