Preliminary trials with 24,25-dihydroxyvitamin D3 in dialysis osteomalacia

Fifteen patients with dialysis osteomalacia were treated with 24,25-dihydroxyvitamin D3 in dosages up to 10 micrograms per day for two to 24 months. All had previously had no improvement during treatment with calcitriol but had been remarkably susceptible to hypercalcemia. When 24,25-dihydroxyvitamin D3 was given with either calcitriol or dihydrotachysterol, serum calcium levels were significantly lower than during treatment with calcitriol or dihydrotachysterol alone. Eight of nine patients who received combined therapy with 24,25-dihydroxyvitamin D3 and calcitriol for longer than two months had clinical improvement; six patients underwent repeated bone biopsy and showed evidence of improved bone mineralization. Patients who received 24,25-dihydroxyvitamin D3 alone did not improve clinically. Since 24,25-dihydroxyvitamin D3 appears to improve calcium homeostasis and bone mineralization in some patients with severe dialysis osteomalacia when administered with 1-hydroxylated vitamin D metabolites, further controlled studies are warranted.     

Lack of effect of 24,25-dihydroxyvitamin D3 administration on parameters of calcium metabolism

Seven patients with disordered calcium metabolism and high normal or elevated serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] were studied before and after the administration of 24,25-(OH)2D3 to determine its effects on calcium metabolism. Despite a significant increase in the mean serum 24,25-(OH)2D level [2.1 +/- 0.6 (+/- SE) to 16.7 +/- 6.2 nmol/L; P less than 0.05] after a daily dose of 20 micrograms for 1 month, there were no consistent changes in serum calcium, immunoreactive PTH, or 1,25-(OH)2D concentrations. Intestinal calcium absorption and urinary calcium excretion rose slightly during 24,25-(OH)2D administration in the majority of the patients. In the three patients in whom it was measured, serum 1,24,25-trihydroxyvitamin D levels did not change (19 +/- 5 vs. 20 +/- 5 pmol/L). We conclude that exogenous 24,25-(OH)2D3 at this dose has no significant antagonistic action on 1,25-(OH)2D and may have weak agonistic action.     

Influence of 1 alpha-hydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 on experimentally induced heterotopic ossification in rats

We report the effects of 1 alpha-OH-D3 and 24,25(OH)2D3, either alone or combined, on new bone formation induced by demineralized cortical bone matrix transplanted extraskeletally to the abdominal muscle wall in rats. 1 alpha-OH-D3 was administered orally in dosages of 0.1 microgram, 24,25(OH)2D3 in dosages of 0.2 micrograms, and, in the combined procedure, in the same dosages as mentioned above per day and rat. The amount of induced new bone in respect of organic matter, mineral content and 45Ca activity increased in all treatment groups, compared with controls. The differences between the groups treated separately with 1 alpha-OH-D3 or 24,25(OH)2D3 were insignificant. The differences in the combined treatment group were not so profound, but differed considerably compared with controls. However, 1 alpha-OH-D3 showed more prominent effects on the mineralization of implanted grafts, while 24,25(OH)2D3 especially promoted the production of organic material of the newly formed bone.     

Metabolism of 25-hydroxyvitamin D3 to 24,25-dihydroxyvitamin D3 and its sensitivity to ketoconazole in 1 alpha,25-dihydroxyvitamin D3-differentiated HL60 cells

Regulation of the metabolism of [3H]25-hydroxyvitamin D3 ([ 3H]25-(OH)D3) in vitro to material with the characteristics of [3H]24,25-dihydroxyvitamin D3 ([3H]24,25-(OH)2D3) has been studied in the human promyelocytic cell line HL60. Synthesis of 24,25-(OH)2D3 was induced in a dose-dependent manner in cells pretreated with 0.1-100 nM 1 alpha,25-dihydroxyvitamin D3 (1 alpha,25-(OH)2D3) for 4 days. This treatment also inhibited cell proliferation and stimulated differentiation to a macrophage phenotype that was characterized by staining for non-specific esterase (NSE) activity. The ability to synthesize [3H]24,25-(OH)2D3 from [3H]25-(OH)D3 and the expression of NSE activity both responded to changes in concentration of 1 alpha,25-(OH)2D3 in the culture medium in a parallel manner. Synthesis of [3H]24,25-(OH)2D3 was linear when the incubation time was between 1 and 8 h and the cell number between 1 and 12 x 10(6) cells/incubation. The optimum substrate concentration for its synthesis was 125 nM, giving an apparent Michaelis constant of 360 nM. The identity of the [3H]24,25-(OH)2D3 synthesized by these cells was confirmed by co-chromatography with authentic 24,25-(OH)2D3 on normal-phase and reverse-phase high-performance liquid chromatography systems and by its reaction to sodium-m-periodate. Cells that had been exposed to 100 nM 1 alpha,25-(OH)2D3 for 4 days synthesized 2.17 +/- 0.07 (S.E.M.) pmol 24,25-(OH)2D3/10(6) cells per h.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decreased Conversion of 25-hydroxyvitamin D3 to 24,25-dihydroxyvitamin D3 Following Cholecalciferol Therapy in Patients with CKD

Background and objectives

Elevated concentrations of fibroblast growth factor 23 (FGF23) are postulated to promote 25-hydroxyvitamin D (25[OH]D) insufficiency in CKD by stimulating 24-hydroxylation of this metabolite, leading to its subsequent degradation; however, prospective human studies testing this relationship are lacking.

Design, setting, participants, & measurements

An open-label prospective study was conducted from October 2010 through July 2012 to compare the effect of 8 weeks of oral cholecalciferol therapy (50,000 IU twice weekly) on the production of 24,25(OH)₂D₃ in vitamin D–insufficient patients with CKD (n=15) and controls with normal kidney function (n=15). Vitamin D metabolites were comprehensively profiled at baseline and after treatment, along with FGF23 and other mineral metabolism parameters.

Results

Vitamin D₃ and 25(OH)D₃ concentrations increased equivalently in the CKD and control groups following cholecalciferol treatment (median D₃ change, 8.6 ng/ml [interquartile range, 3.9–25.6 ng/ml] for controls versus 12.6 ng/ml [6.9–41.2 ng/ml] for CKD [P=0.15]; 25(OH)D₃ change, 39.2 ng/ml [30.9–47.2 ng/ml] for controls versus 39.9 ng/ml [31.5–44.1 ng/ml] for CKD [P=0.58]). Likewise, the absolute increase in 1α,25(OH)₂D₃ was similar between CKD participants and controls (change, 111.2 pg/ml [64.3–141.6 pg/ml] for controls versus 101.1 pg/ml [74.2–123.1 pg/ml] for CKD; P=0.38). Baseline and post-treatment 24,25(OH)₂D₃ concentrations were lower in the CKD group; moreover, the absolute increase in 24,25(OH)₂D₃ after therapy was markedly smaller in patients with CKD (change, 2.8 ng/ml [2.3–3.5 ng/ml] for controls versus 1.2 ng/ml [0.6–1.9 ng/ml] for patients with CKD; P<0.001). Furthermore, higher baseline FGF23 concentrations were associated with smaller increments in 24,25(OH)₂D₃ for individuals with CKD; this association was negated after adjustment for eGFR by multivariate analysis.

Conclusions

Patients with CKD exhibit an altered ability to increase serum 24,25(OH)₂D₃ after cholecalciferol therapy, suggesting decreased 24-hydroxylase activity in CKD. The observed relationship between baseline FGF23 and increments in 24,25(OH)₂D₃ further refutes the idea that FGF23 directly contributes to 25(OH)D insufficiency in CKD through stimulation of 24-hydroxylase activity.     

Effect of 24,25-dihydroxyvitamin D3 on 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] metabolism in vitamin D-deficient rats infused with 1,25-(OH)2D3

Previous studies revealed that administration of 24,25-dihydroxyvitamin D3 [24,25-(OH)2D3] to calcium (Ca)-deficient rats causes a dose-dependent reduction in markedly elevated serum 1,25-(OH)2D3 level. Although the results suggested that the metabolism of 1,25-(OH)2D3 was accelerated by 24,25-(OH)2D3, those experiments could not define whether the enhanced metabolism of 1,25-(OH)2D3 played a role in the reduction in the serum 1,25-(OH)2D3 level. In the present study, in order to address this issue more specifically, serum 1,25-(OH)2D3 was maintained solely by exogenous administration through miniosmotic pumps of 1,25-(OH)2D3 into vitamin D-deficient rats. Thus, by measuring the serum 1,25-(OH)2D3 concentration, the effect of 24,25-(OH)2D3 on the MCR of 1,25-(OH)2D3 could be examined. Administration of 24,25-(OH)2D3 caused a dose-dependent enhancement in the MCR of 1,25-(OH)2D3, and 1 microgram/100 g rat.day 24,25-(OH)2D3, which elevated serum 24,25-(OH)2D3 to 8.6 +/- 1.3 ng/ml, significantly increased MCR and suppressed serum levels of 1,25-(OH)2D3. The effect of 24,25-(OH)2D3 on 1,25-(OH)2D3 metabolism developed with a rapid time course, and the recovery of iv injected [1 beta-3H]1,25-(OH)2D3 in blood was significantly reduced within 1 h. In addition, there was an increase in radioactivity in the water-soluble fraction of serum as well as in urine, suggesting that 1,25-(OH)2D3 is rapidly degraded to a water-soluble metabolite(s). Furthermore, the reduction in serum 1,25-(OH)2D3 was associated with a reduction in both serum and urinary Ca levels. Because the conversion of [3H]24,25-(OH)2D3 to [3H]1,24,25-(OH)2D3 or other metabolites was minimal in these rats, 24,25-(OH)2D3 appears to act without being converted into other metabolites. These results demonstrate that 24,25-(OH)2D3 rapidly stimulates the metabolism of 1,25-(OH)2D3 and reduces its serum level. It is suggested that 24,25-(OH)2D3 plays a role in modifying serum 1,25-(OH)2D3 concentrations by affecting the metabolism of 1,25-(OH)2D3 and may have a therapeutic values in the treatment of hypercalcemia or hypercalciuria caused by 1,25-(OH)2D3 excess.     

Biochemical characterization and purification of a binding protein for 24,25-dihydroxyvitamin D3 from chick intestine.

An earlier study revealed that 24R,25-dihydroxyvitamin D(3) (24R,25(OH)(2)D(3)) inhibits the rapid actions of 1,25(OH)(2)D(3) on stimulation of calcium transport in perfused duodena, as well as activation of protein kinases C and A. In the present work, a specific binding protein (24,25-BP) has been identified and partially characterized. Percoll-gradient resolution of differential centrifugation fractions from mucosal homogenates revealed the highest levels of specific [(3)H]24R,25(OH)(2)D(3) binding to be in lysosomes (approximately eight to tenfold greater than in basal lateral membrane fractions). Incubation of isolated enterocytes with 6.5 nM [(3)H]24R,25(OH)(2)D(3) for 10 s also demonstrated targeting of the steroid to lysosomal fractions. Using freshly isolated lysosomal fractions, time course studies indicated maximal specific binding after a 2-h incubation on ice. Western analyses revealed that the serum transport protein, DBP (vitamin D binding protein), was absent from both lysosomal and basal lateral membrane fractions. Protein dependence studies demonstrated linear binding between 0.05 and 0.155 mg of lysosomal protein. Saturation analyses yielded K(d)=7.4+/- 1.8 nM, B(max)=142+/-16 fmol/mg protein for lysosomes, and K(d)=8.5 nM, B(max)=149+/-25 fmol/mg protein for basal lateral membranes. Hill analyses of lysosomal binding yielded a Hill coefficient of 0.57+/-0.11, indicative of negative cooperativity. Studies with lysosomal proteins revealed a 81%+/-7% competition of 24S,25(OH)(2)D(3) with [(3)H]24R,25(OH)(2)D(3) for binding (P>0.05, relative to competition with 24R,25(OH)(2)D(3)), while 25(OH)D(3) and 1,25(OH)(2)D(3) yielded 53%+/-13% and 39%+/-11% competition respectively (each, P<0.05, relative to competition with 24R,25(OH)(2)D(3)). The apparent affinity of 24S,25(OH)(2)D(3) for 24,25-BP led to testing of the metabolites effectiveness in the perfused duodenal loop system. Vascular perfusion with 130 pM 1,25(OH)(2)D(3) stimulated (45)Ca transport to 2.5-fold above control levels after 40 min, while simultaneous perfusion with 6.5 nM 24S,25(OH)(2)D(3) and 130 pM 1,25(OH)(2)D(3) abolished the stimulatory activity completely. Purification of the 24,25-BP by chromatography revealed a single protein band upon SDS-PAGE and silver staining of 66 kDa. The combined results suggest that 24R,25(OH)(2)D(3) may mediate its hormonal activities through a specific binding protein.     

Environmental salinity regulates receptor expression,cellular effects,and circulating levels of two antagonizing hormones, 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3, in rainbow trout

In freshwater-adapted rainbow trout, intestinal cells (enterocytes) possess receptors for 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] in the basolateral membrane, and respond to treatment with 1,25(OH)(2)D(3) with increased intracellular calcium concentrations. No receptors are found for the antagonizing hormone 24,25-dihydroxyvitamin D(3) [24,25(OH)(2)D(3)] at the enterocyte basolateral membrane, and it has no effect on enterocyte calcium homeostasis. After acclimation to seawater, however, the enterocyte membrane receptors for 1,25(OH)(2)D(3) are down-regulated and specific binding for 24,25(OH)(2)D(3) appears, which is further up-regulated with time spent in seawater. This shift in receptor expression is concurrent with an increased sensitivity of the enterocytes to 24,25(OH)(2)D(3) and a decreased sensitivity to 1,25(OH)(2)D(3). This results in a partial inhibition of intracellular calcium uptake, which would be beneficial when inhabiting a calcium-rich environment like seawater.     

Correlation between serum osteocalcin and 24,25-dihydroxyvitamin D levels in Paget's disease of bone

We have studied the possible correlation between serum 24,25-dihydroxyvitamin D [24,25-(OH)2D] and osteocalcin levels (sBGP) in Paget's disease of bone. We measured serum calcium, phosphate, PTH, 25-hydroxyvitamin D, 1,25-(OH)2D, 24,25-(OH)2D, alkaline phosphatase (sAP), and the urinary hydroxyproline/creatinine ratio (UOH prol/creat) in 19 patients with Paget's disease of bone and 16 age- and sex-matched controls. As expected, sAP, UOH prol/creat, and sBGP levels were significantly elevated, and there was a tendency to a decrease in serum levels of 24,25-(OH)2D in Pagetic patients with respect to the control group. There was no significant difference between patients and controls in serum calcium, phosphate, PTH, 25-hydroxyvitamin D, and 1,25-(OH)2D. The Pagetic patients were subdivided into two subgroups; subgroup A had normal sBGP levels (less than 5 ng/mL), and subgroup B had increased sBGP levels (greater than 5 ng/mL). Serum 24,25-(OH)2D levels in subgroup B were significantly lower than those in controls, while subgroup A showed levels similar to those in the control group. We also found a positive linear correlation between sAP and sBGP and between sAP and UOH prol/creat as well as a negative linear correlation between sBGP and 24,25-(OH)2D and between 24,25-(OH)2D and UOH prol/creat in Pagetic patients. These results point to a possible role of 24,25-(OH)2D in disease activity.     

Primary hyperparathyroidism with low serum 1,25-dihydroxyvitamin D levels

Primary hyperparathyroidism is usually associated with normal or elevated serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] levels. We report a patient with extreme hypercalcemia (serum calcium, 19.4 mg/dl), primary hyperparathyroidism, and a very low plasma concentration of 1,25-(OH)2D. Surgical removal of a large parathyroid adenoma was associated with a decrease in the serum calcium and immuno- and bioactive PTH concentrations and normalization of the 1,25-(OH)2D level. The postoperative course was complicated by severe protracted hypocalcemia and cardiac arrest, requiring treatment with large doses of calcium iv. The low concentrations of 1,25-(OH)2D in this patient are an unusual manifestation of primary hyperparathyroidism, probably due to suppression of renal 1 alpha-hydroxylase activity by the severe hypercalcemia. We conclude that in severe hypercalcemia, a low serum 1,25-(OH)2D level does not exclude the diagnosis of primary hyperparathyroidism.     

Vitamin D status in primary hyperparathyroidism

Background

Hypovitaminosis D worsens the manifestations of primary hyperparathyroidism (PHPT). Only a few studies have assessed the status of vitamin D in PHPT. The objective of this study was to determine the prevalence of 25(OH)D levels < 50 nmol/L in PHPT in comparison to a population without PHPT.

Methods

Subjects with PHPT were identified from the computerized database of the Clalit Health Services in Israel and were included only if they had an available serum 25(OH)D test result in 2009 and were not taking vitamin D supplements in 2008-2009 prior to the 25(OH)D test result. Subjects with renal failure were excluded (included n = 1180). All other subjects with an available 25(OH)D value in 2009 constituted the control group (n = 184,479).

Results

Subjects with PHPT and 25(OH)D < 50 nmol/L had higher levels of serum PTH, alkaline phosphatase, and calcium levels compared to those with 25(OH)D levels ≥ 50 nmol/L (P < 0.02). The mean serum 25(OH)D level was 47.7 ± 22.5 nmol/L compared to 52.1 ± 24.5 nmol/L in the control group (P < 0.001). 59.6% of subjects with PHPT had 25(OH)D levels < 50 nmol/L as compared to 49.5% in the control group (P < 0.001). Logistic regression, controlling for gender, ethnicity, age, and seasonality, showed that PHPT independently predicted 25(OH)D levels < 50 nmol/L; OR = 1.61(95% CI, 1.43-1.82).

Conclusions

Serum 25(OH)D levels < 50 nmol/L are frequent in PHPT, are more common than in controls, and are associated with more severe bone disease based on higher serum PTH and bone turnover biomarkers.     

Perinatal vitamin D metabolism. IV. Maternal and cord serum 24,25-dihydroxyvitamin D concentrations.

Fetal and maternal compartments differ in factors shown to regulate 24.25 dihydroxyvitamin D [24,25(OH)2D] metabolism [calcium, phosphorus, and parathyroid hormone (PTH)] such that one might predict that maternal serum 24,25(OH)2D levels are decreased and fetal 24,25(OH)2D concentrations are increased. To evaluate this, 25-hydroxyvitamin D (25OHD), 24,25(OH)2D, calcium, magnesium, calcitonin, and PTH were measured in 24 paired maternal and cord sera. The mean maternal serum 24,25(OH)2D concentration (2.9 +/- 0.26 ng/ml) was significantly lower than that of nonpregnant females (3.9 +/- 0.37 ng/ml). Mean serum PTH and calcitonin levels were, however, normal in maternal sera. The normal elevations of PRL, estrogen, and placental lactogen in serum of pregnant women could possibly decrease 24,25(OH)2D production, as seen in animal experimental systems. There was no correlation (R = -0.25) between 24,25(OH)2D levels in maternal and cord sera, as predicted; however, mean (+/-SE) fetal 24,25(OH)2D (2.5 +/- 0.26 ng/ml) was similar to the mean maternal concentration and significantly below the mean level in normal adults. The low fetal 24,25(OH)2D concentration may be due to 1) decreased 24-hydroxylase capacity of the fetus; 2) regulation by fetal factors other than calcium, phosphorus, and PTH; or 3) increased utilization of 24,25(OH)2D possibly for fetal bone mineralization.     

1,25-dihydroxyvitamin D suppresses circulating levels of parathyroid hormone in a patient with primary hyperparathyroidism and coexistent sarcoidosis

CONTEXT: PTH is excessively secreted to develop hypercalcemia and accelerate bone turnover in patients with primary hyperparathyroidism. PTH stimulates the production of 1,25-dihydroxyvitamin 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.     

Production of 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 by growth zone and resting zone chondrocytes is dependent on cell maturation and is regulated by hormones and growth factors.

1,25-Dihydroxyvitamin D3 [1,25-(OH)2D3] and 24,25-(OH)2D3 have been shown to promote chondrocyte proliferation and differentiation; resting zone chondrocytes respond primarily to 24,25-(OH)2D3, whereas growth zone chondrocytes respond primarily to 1,25-(OH)2D3. This study determined whether resting zone and growth zone cells produce 24,25-(OH)2D3 or 1,25-(OH)2D3; whether this production is regulated by 1,25-(OH)2D3 (10(-8) M), 24,25-(OH)2D3 (10(-7) M), dexamethasone (10(-7) M), or recombinant human transforming growth factor-beta 1 (11 ng/ml); and whether the metabolites produced are biologically active. Confluent fourth passage rat costochondral growth zone or resting zone chondrocytes were cultured in Dulbecco's Modified Eagle's Medium containing [3H]25-hydroxyvitamin D3 ([3H]25OHD3), 2% fetal bovine serum, and antibiotics. Metabolism of [3H]25OHD3 was measured by analyzing the lipid extracts of the conditioned medium and the cell layer for [3H]1,25OHD3, [3H]1,25-(OH)2D3, and [3H]24,25-(OH)2D3 using flow-through scintillation spectroscopy of HPLC eluates. Chemically synthesized radioinert vitamin D3 metabolites were used as standards, and their migration was determined by absorbance at 254 nm. To ensure that the radioactive peaks were 1,25-(OH)2D3 and 24,25-(OH)2D3, the fractions were rechromatographed into three other HPLC solvent systems. Biological activity was confirmed; the addition of HPLC-purified 1,25-(OH)2D3 produced by growth zone chondrocytes elicited a dose-dependent stimulation of alkaline phosphatase specific activity in growth zone cell cultures, but had no effect on the resting zone cells. There was a time-dependent increase in both [3H]1,25-(OH)2D3 and [3H]24,25-(OH)2D3 in the conditioned medium of both types of cultures. At 24 h, the percent conversion of [3H]25OHD3 to [3H]1,25-(OH)2D3 was 5.3 +/- 1.2, and the percent conversion to [3H]24,25-(OH)2D3 was 1.8 +/- 0.4 in growth zone chondrocyte cultures. No such effect was found in cultures freeze-thawed five times or without cells. When resting zone cells were cultured with [3H]25OHD3, the percent conversion to 1,25-(OH)2D3 and 24,25-(OH)2D3 was 4.5 +/- 1.0 and 1.7 +/- 0.4, respectively. The addition of dexamethasone significantly increased the percent production of 1,25-(OH)2D3 at 6 and 24 h and at 6 h by resting zone and growth zone cells, respectively, compared to the control values. Recombinant human transforming growth factor-beta 1 increased the percent production of 1,25-(OH)2D3 after 1 h in resting zone cells and, after 24 h, the production of 24,25-(OH)2D3 in growth zone cells. Radiolabeled 1,25-(OH)2D3 and 24,25-(OH)2D3 were not detected in the cell layer.(ABSTRACT TRUNCATED AT 400 WORDS)     

Effect of parathyroidectomy on serum 1 alpha,25-dihydroxyvitamin D and intestinal calcium absorption in primary hyperparathyroidism.

Serum concentration of 1 alpha,25-dihydroxyvitamin D [1,25(OH)2D] and intestinal absorption were measured before and after parathyroidectomy in 11 patients with primary hyperparathyroidism. Serum 1,25(OH)2D was high preoperatively (P less than 0.001) and normal postoperatively. Ca absorption was elevated preoperatively (P less than 0.001) and decreased significantly after parathyroidectomy (P less than 0.001). However, 5 of 11 patients had a persistent hyperabsorption of Ca postoperatively, despite normal serum 1,25(OH)2D. The results suggest that factors other than 1,25(OH)2D contribute to the maintenance of high intestinal Ca absorption in hyperparathyroid patients in the postoperative state.