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Vitamin D supplementation in primary hyperparathyroidism: effects on 1,25(OH)2 vitamin D and FGF23 levels

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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 D3 for 12 weeks. At baseline and endpoint, blood samples were collected to measure 1,25(OH)2vitamin D (1,25(OH)2D), intact Fibroblast Growth Factor 23 (FGF23), 25OHD, Parathormone, and other biochemical markers. The 1,25(OH)2D 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)2D 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)2D 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)2D 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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Fig. 1

Data availability

Data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the Laboratories of Grupo Fleury, São Paulo, Brazil, for performing the FGF23 and the 1,25(OH)2 vitamin D measurements. We thank the Coordenaçao para o Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) for supporting the Post-graduation Program of Endocrinology at the Universidade Federal de São Paulo (UNIFESP).

Funding

This research was funded by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Mantecorp-Farmasa Inc kindly provided the vitamin D3 (Addera D3) used in this study. SGP received doctor scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq, and the Comissao de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) supports the Post-Graduation Program of UNIFESP.

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Authors and Affiliations

  1. Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu, 591, Cj 93-94, Vila Mariana, São Paulo, 04023-062, Brazil

    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. Brandão, J. G. H. Vieira & M. Lazaretti-Castro

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  1. S. G. Pallone
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  2. M. N. Ohe
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  3. L. M. dos Santos
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  4. I. O. Nacaguma
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  5. I. S. Kunii
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  6. R. E. C. da Silva
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  8. C. M. A. Brandão
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  9. J. G. H. Vieira
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Correspondence to M. N. Ohe.

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Research involving human participants and/or animals

The study was approved by the Ethics and Research Committee of the Federal University of São Paulo (registration number 89044117.9.0000.5505).

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Pallone, S.G., Ohe, M.N., dos Santos, L.M. et al. Vitamin D supplementation in primary hyperparathyroidism: effects on 1,25(OH)2 vitamin D and FGF23 levels. J Endocrinol Invest (2024). https://doi.org/10.1007/s40618-024-02422-2

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