Resolution of hypercalcemia in primary hyperparathyroidism with vitamin D replacement

Area of Science:

• Endocrinology
• Metabolic Bone Disease

Background:

• Primary hyperparathyroidism (PHPT) is frequently associated with vitamin D deficiency.
• Vitamin D deficiency can complicate the diagnosis and management of PHPT.

Observation:

• A case of PHPT with a positive parathyroid scan and history of nephrolithiasis presented with vitamin D deficiency.
• Despite normal albumin and renal function, the patient's vitamin D levels were low.

Findings:

• Vitamin D supplementation over 13 months led to a parallel decline in parathyroid hormone and increase in vitamin D levels.
• Total serum calcium normalized, but ionized calcium remained persistently elevated during treatment.

Implications:

• Vitamin D deficiency requires careful monitoring in patients with primary hyperparathyroidism.
• The interplay between vitamin D status and calcium/parathyroid hormone levels in PHPT warrants further investigation.