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Primary hyperparathyroidism with low serum 1,25-dihydroxyvitamin D levels
The Journal of Clinical Endocrinology and Metabolism
|June 1, 1986
Summary
Extreme hypercalcemia can present with low vitamin D levels in primary hyperparathyroidism. This case highlights that low 1,25-dihydroxyvitamin D does not rule out this diagnosis.
Area of Science:
- Endocrinology
- Metabolic Bone Disease
Background:
- Primary hyperparathyroidism typically presents with normal or elevated serum 1,25-dihydroxyvitamin D [1,25-(OH)2D].
- Severe hypercalcemia is a less common, yet significant, clinical presentation.
Observation:
- A patient with primary hyperparathyroidism exhibited extreme hypercalcemia (serum calcium 19.4 mg/dl) and markedly low plasma 1,25-(OH)2D.
- Surgical resection of a parathyroid adenoma normalized calcium and parathyroid hormone (PTH) levels, along with 1,25-(OH)2D.
Findings:
- This case demonstrates an unusual presentation of primary hyperparathyroidism with suppressed 1,25-(OH)2D.
- The low 1,25-(OH)2D is likely due to suppression of renal 1 alpha-hydroxylase activity by severe hypercalcemia.
Implications:
- A low serum 1,25-(OH)2D level in the context of severe hypercalcemia does not exclude the diagnosis of primary hyperparathyroidism.
- This finding is crucial for accurate diagnosis and management of hypercalcemic disorders.