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1,25-Dihydroxyvitamin D Suppresses Circulating Levels of Parathyroid Hormone in a Patient with Primary Hyperparathyroidism and Coexistent Sarcoidosis

Divisions of Endocrinology (Y.K., M.T., A.T., Y.T.) and Endocrine Surgery (D.M., S.T.), Toranomon Hospital Endocrine Center, Tokyo 105-8470, Japan; and Okinaka Memorial Institute for Medical Research (M.T., A.T., D.M., S.T., Y.T.), 105-8470 Tokyo, Japan

Address all correspondence and requests for reprints to: Yasuhiro Takeuchi, M.D., Ph.D., Toranomon Hospital Endocrine Center, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan. E-mail: takeuchi-tky{at}umin.ac.jp.

Context: PTH is excessively secreted to develop hypercalcemia and accelerate bone turnover in patients with primary hyperparathyroidism. PTH stimulates the production of 1,25-dihydorxyvitamin D [1,25(OH)₂D] that in turn suppresses the synthesis of PTH in parathyroid cells.

Objective: The objective of the study was to clarify whether 1,25(OH)₂D indeed inhibits circulating levels of PTH and influences bone turnover, even in a patient with primary hyperparathyroidism.

Design, Setting, and Patient: We evaluated PTH levels in a patient with primary hyperparathyroidism and coexistent sarcoidosis whose serum 1,25(OH)₂D levels were independent of PTH.

Interventions and Main Outcome Measures: The present case was treated with prednisolone before and after surgical resection of parathyroid adenoma, and Ca-regulating hormones and bone markers were measured.

Results: Serum Ca and PTH levels significantly decreased after parathyroid surgery, whereas serum 1,25(OH)₂D levels remained high. Prednisolone administration promptly decreased serum 1,25(OH)₂D levels and reciprocally increased PTH levels despite consistent serum Ca levels either before or after surgery. PTH levels were negatively correlated with serum 1,25(OH)₂D levels before and after surgery. Urine N-telopeptides, serum osteocalcin, and bone-type alkaline phosphatase all decreased to physiological ranges after parathyroid surgery.

Conclusions: These results suggest that 1,25(OH)₂D indeed inhibits the production of PTH not to exacerbate hypercalcemia in a patient with primary hyperparathyroidism. Furthermore, PTH but not 1,25(OH)₂D may primarily be involved in the stimulation of bone turnover.

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				B Moosgaard, P Vestergaard, L Heickendorff, F Melsen, P Christiansen, and L Mosekilde Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study. Eur. J. Endocrinol., August 1, 2006; 155(2): 237 - 244. [Abstract] [Full Text] [PDF]