title: Vitamin D treatment in primary hyperparathyroidism.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) and vitamin D insufficiency are two very frequent conditions. In cases where the combination of both vitamin D insufficiency and PHPT is diagnosed, vitamin D repletion is an option. However, only limited evidence exists for this treatment.
  
  
  OBJECTIVE
  The aim of this review is to describe different aspects of concomitant vitamin D insufficiency and PHPT and in this setting to evaluate existing evidence on safety and possible outcome of vitamin D treatment.
  
  
  METHODS
  Background literature was found based on a search in pubmed.com and scirus.com.
  
  
  RESULTS
  Multiple association studies support the hypothesis that the clinical presentation of PHPT is more severe in patients with vitamin D insufficiency. Treatment with vitamin D in PHPT may decrease PTH levels and bone turnover and potentially increase bone mass in various compartments. However, some patients experience increasing plasma or urine levels of calcium, triggering either vitamin D withdrawal or surgery.
  
  
  CONCLUSIONS
  Measurement of vitamin D in PHPT is important to fully assess the disorder. The causality of the frequent coexistence of vitamin D insufficiency and PHPT is not fully understood. Vitamin D treatment is recommended and may decrease PTH levels in PHPT. However, there is no randomized controlled trial to prove any beneficial effect. For safety reasons, it is recommended to monitor plasma and urinary calcium during treatment. Furthermore, the effect of vitamin D repletion on other outcomes like quality of life, muscle function and CNS symptoms should be assessed.
authors.affiliation: Department of Surgery, Aarhus University Hospital, THG, Aarhus C, Denmark. larsrolighed@gmail.com
authors.forename: Lars
authors.initials: L
authors.lastname: Rolighed
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D000818:Animals; D016723:Bone Remodeling; D002118:Calcium / Q000378:metabolism; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood; D012720:Severity of Illness Index; D014807:Vitamin D / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium