Progressively Increased Serum 1, 25-DihXdroxyvitamin D2 Concentration in a Hypoparathyroid Patient with Protracted Hypercalcemia due to Vitamin D2 Intoxication

Endocrine Journal

NORIHIDE TSUJI³  SHIGEKI INABA³  KANJI SATO¹  TADASHI KOBAYASHI²  TOSHIO TSUSHIMA¹  NAOYA EMOTO¹  SHOZO TORAYA¹  ATSUKO TAKEUCHI²  HIROSHI DEMURA¹ 

[1]Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical College

[2]Department of Hygienic Sciences, Kobe Pharmaceutical University

[3]Fuchu Hospital

关键词: Hypercalcemia;    Vitamin D intoxication;    Bisphosphonate;    1;    25-Dihydroxyvitamin D;    Hypoparathyroidism;   

DOI  :  10.1507/endocrj.41.329

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(38)Cited-By(5)A 76-year-old female patient who had been taking vitamin D2 100, 000U/day for more than 14 years due to hypoparathyroidism following total thyroidectomy was admitted because of protracted hypercalcemia.On admission, the levels of serum vitamin D2 (99.8ng/ml) and 25-OHD2 (356ng/ml) were very high, and 1, 25-(OH)2D2 was low (4.0-18.7pg/ml). Serum D3, 25-OHD3 and 1, 25-(OH)2D3 were below the normal range. Despite intensive hydration with saline, intravenous hyperalimentation with phosphate-and calcium-free nutrients, and administration of glucocorticoid and calcitonin, the hypercalcemia persisted, accompanied by hypoproteinemia, edema, pleural effusion and congestive heart failure. The serum D2 and 25-OHD2 concentrations remained high and were accompanied by a gradual increase in 1, 25-(OH)2D2 (121pg/ml), which further increased after the administration of bisphosphonate (pamidronate) to 183pg/ml. Seventeen months later, serum calcium and 1, 25-(OH)2D2 were normalized but serum D2 and 25-OHD2 remained high. The serum 24, 25-(OH)2D2/25-OHD2 ratio was relatively constant throughout her clinical course, whereas the low serum 1, 25-(OH)2D2/25-OHD2 ratio at admission gradually increased during admission, suggesting that the increase in serum 1, 25-(OH)2D2 is due to increased production rather than decreased degradation. The administration of pamidronate further increased serum 1, 25-(OH)2D2.These features of the clinical course demonstrate that the 1, 25-dihydroxyvitamin D concentration in hypercalcemic patients with protracted vitamin D intoxication may be decreased, normal or increased. Possible factors responsible for a protracted increase in serum 1, 25-(OH)2D2 are body weight loss, hypoproteinemia, and phosphate depletion. In addition, some bisphosphonates would certainly promote PTH-independent production of 1, 25-(OH)2D2.

【 授权许可】

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