Vitamin D Deficiency and Primary Hyperparathyroidism (PHTP)

Rodrigo Arrangoiz MS, MD, FACS, FSSO

Obtaining measurements of vitamin D metabolites (usually 25 OH Vitamin D) may be useful to distinguish PHPT from other conditions and it can help confirm the diagnosis of PHPT.

The vast majority of patients with PHPT will have concomitant vitamin D deficiency. In a series of more than 10,000 patients with proven PHPT found that 77% of patients had 25 OH Vitamin D levels below 30 ng/ ml (normal range above 35 ng/ml), 36% had levels below 20 ng/ml, and none of the patients had elevated 25 OH Vitamin D levels.

  • In this study they also found an increase conversion of 25 OH Vitamin D to 1-25 OH Vitamin D.

    • A vitamin D deficiency is something to expect in patients with PHPT with an average value of 22.4 ng/ml.

Low vitamin D levels do NOT cause high levels of serum calcium.

The notion that vitamin D deficiency causes a decrease in the serum calcium levels (because of a decrease intestinal absorption) and that this decrease in serum calcium concentration will lead to an activation of the parathyroid glands, with subsequent parathyroid gland hyperplasia and increase PTH secretion leading to hypercalcaemia should be rethought (Figure).

  • Norman et al., , showed that 98% of the patients in their study who had PHPT with concomitant vitamin D deficiency had a parathyroid adenoma and only two percent had parathyroid gland hyperplasia refuting the current thinking.
  • Shah et al., performed a meta-analysis of the world literature in 2014 and concluded Vitamin D replacement in subjects with PHPT and coexistent vitamin D deficiency increase 25 (OH) D and reduces serum PTH significantly without causing hypercalcemia and hypercalciuria but mentioned that the finding of there study needs to be confirmed by larger randomized control trials.

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Rodrigo Arrangoiz MS, MD, FACS
Cirugía Oncológica
Fox Chase Cancer Center
Tumores de Cabeza y Cuello / Cirugía Endocrina
Fox Chase Cancer Center
Tumores de Cabeza y Cuello / Cirugía Endocrina
IFHNOS / Memorial Sloan Kettering Cancer Center
Maestría en Ciencias de Investigación
Drexel University
Certificado por el Colegio Americano de Cirugía
Fellow del Colegio Americano de Cirugía
Fellow de la Sociedad de Cirugia Oncológica  
#hyperparathyroidism
#hypercalcemia
#vitaminDdeficiency
#Endocrinesurgeon
#headandnecksurgeon
#MountSinaiMedicalCenter
#MSMC
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#Mexico
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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