Document Detail

Reduced PTH Stimulated 1,25-Dihydroxyvitamin D Production in Vitamin D Sufficient Postmenopausal Women with Low Bone Mass and Idiopathic Secondary Hyperparathryroidism.
MedLine Citation:
PMID:  23186957     Owner:  NLM     Status:  Publisher    
Objective: Distinguishing sHPT from eucalcemic primary hyperparathyroidism (EC-pHPT) is important. The objective of this study was to measure PTH-stimulated production of 1,25(OH)2D in early postmenopausal patients with idiopathic sHPT, who also fit the criteria for EC-pHPT, compared to age-matched controls.Methods: In this pilot case-control study, postmenopausal women aged 44-55 with normal serum calcium (Ca), glomerular filtration rate (GFR) ≥65 ml/min, 25(OH)D ≥ 75 nmol/L (30 ng/ml) were given an 8 hour infusion of PTH(1-34), 12 pmol/kg/hr. Patients (n=5) had elevated PTH, normal 1,25(OH)2D and no hypercalciuria. Controls (n=5) had normal PTH. At baseline, 4 and 8 hours serum Ca, creatinine (Cr), phosphorus (P), 1,25(OH)2D, FGF23, 24,25(OH)2D; urine Ca, P, Cr and cAMP/GFR were measured; FeCa, TMP/GFR were calculated.Results: Patients had lower 1,25(OH)2D levels (±SD) than controls at 4 (39.8±6.9 vs 58.8±6.7, p=0.002) and 8 hours (56.4±9.2 vs 105±2.3, p=0.003) of PTH infusion, attenuated after adjusting for higher BMI in patients (p=0.05, 0.04). 24,25(OH)2D levels were lower in patients than controls (1.9±0.6 vs 3.4±0.6, p=0.007). No differences were seen in: serum Ca, P; urine cAMP/GFR, TRP/GFR, FeCa, PTH suppression at 8 hours (patients 50%, controls 64%).Conclusions: Vitamin D sufficient patients who fit the criteria for EC-pHPT, had reduced PTH-stimulated 1,25(OH)2D compared to controls, partially attributable to their higher BMI. Other causes of reduced 1,25(OH)2D production ruled out were excessive catabolism of vitamin D metabolites, elevated FGF23 and CYP27B1 mutation. Elevated BMI and idiopathic reduced PTH-stimulated 1,25(OH)2D production should be considered in the differential of sHPT.
Elizabeth A Streeten; Amy Rogstad; Kristin Flammer; Kiarash Zarbalian; Kathleen Ryan; Mara Horwitz; Michael F Holick; John Shelton
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-27
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  Endocr Pract     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-26     Citation Subset:  -    
University of Maryland School of Medicine, Baltimore, Maryland.
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