title: Treating vitamin D insufficiency in primary hyperparathyroidism: a cautionary tale.
abstract: Vitamin D deficiency is a poorly recognized pandemic and can be associated with primary hyperparathyroidism, which is not infrequently found in the general population. No formal guidelines exist to guide therapy for suboptimal Vitamin D status in patients with hyperparathyroidism. However, there are many potential benefits to achieving a Vitamin D replete state before parathyroid surgery. Previous reports have indicated that Vitamin D status can be improved without adverse effects in hyperparathyroidism. We report accentuation of hypercalcemia and hypercalciuria with Vitamin D treatment (weekly 50,000 IU ergocalciferol x 8 weeks) in a 64-year-old Caucasian male veteran with primary hyperparathyroidism, osteoporosis and Vitamin D insufficiency. The exacerbation of hypercalcemia and hypercalciuria resolved with cessation of Vitamin D therapy. We propose that clinicians consider using modest doses of Vitamin D such as 1,000 IU daily for replacement in patients with hyperparathyroidism and Vitamin D deficiency. We recommend that serum and urine calcium be monitored if such treatment is implemented.
authors.affiliation: Department of Medicine, Mountain Home VA Medical Center, USA.
authors.forename: Warit
authors.initials: W
authors.lastname: Jithpratuck
authors.forename: Linda H
authors.initials: LH
authors.lastname: Garrett
authors.forename: Alan N
authors.initials: AN
authors.lastname: Peiris
mesh_terms: D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D053565:Hypercalciuria / Q000209:etiology; D006961:Hyperparathyroidism / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D014807:Vitamin D / Q000009:adverse effects* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D014807:Vitamin D