Vitamin D Supplementation in Primary Hyperparathyroidism: Effects on 1,25(OH) Vitamin D and FGF23 Levels

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2024 Jun 26

PMID 38922369

Authors

S G Pallone

M N Ohe

L M Dos Santos

I O Nacaguma

I S Kunii

R E C da Silva

S S Maeda

C M A Brandao

J G H Vieira

M Lazaretti-Castro

Affiliations

Soon will be listed here.

Abstract

Purpose: In patients with Primary Hyperparathyroidism (PHPT) vitamin D deficiency has been associated with more severe presentations. Our aim was to investigate the effects of Vitamin D supplementation on mineral homeostasis and related hormones in individuals with and without PHPT.

Methods: Individuals with and without PHPT (CTRL) received 14,000 IU/week of oral vitamin D for 12 weeks. At baseline and endpoint, blood samples were collected to measure 1,25(OH)vitamin D (1,25(OH)D), intact Fibroblast Growth Factor 23 (FGF23), 25OHD, Parathormone, and other biochemical markers. The 1,25(OH)D measurement was performed using liquid chromatography and mass spectrometry (LC-MS/MS).

Results: 70 PHPT patients and 75 CTRL were included, and 55 PHPT and 64 CTRL completed the 12-week protocol. After the intervention, there were significant increases in the FGF23 levels (PHPT: 47.9 ± 27.1 to 76.3 ± 33.3; CTRL: 40.5 ± 13.9 to 59.8 ± 19.8 pg/mL, p < 0.001), and significant decreases in 1,25(OH)D levels (PHPT: 94.8 ± 34.6 to 68.9 ± 25.3; CTRL: 68.7 ± 23.5 to 56.4 ± 20.7 pg/mL, p < 0.001). The reduction of 1,25(OH)D was inversely associated with the increase of FGF23 in both the PHPT (r = -0.302, p = 0.028) and CTRL (r = -0.278, p = 0.027). No changes in plasmatic or uninary calcium concentrations were observed in both groups.

Conclusion: The weekly administration of 14,000 IU of Vitamin D3 was safe and efficient to increase in 25OHD levels in both groups. However, a paradoxical decrease in 1,25(OH)D levels measured by LC-MS/MS was associated with a significant increase in FGF23 levels in both groups. This phenomenon might represent a defense against hypercalcemia after vitamin D supplementation and paves the way for new studies in this regard.

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