Department of Endocrinology and Metabolism, Sisli Etfal Training and Research Hospital, University of Health Sciences Turkey, İstanbul, Turkey.
Int J Clin Pract. 2021 Jul;75(7):e14181. doi: 10.1111/ijcp.14181. Epub 2021 Apr 29.
We aimed to evaluate the risk of hypercalcemia in patients with very high levels of 25-hydroxy vitamin D (25(OH)D).
The distribution of patients who were screened for 25(OH)D in our hospital between January 2014 and December 2018 was evaluated and patients with serum concentrations of 25(OH)D >88 ng/mL were selected. Then, biochemical parameters of the cases with 25(OH)D >88 ng/mL were compared according to calcium status, vitamin D level (group 1, 88-100 ng/mL; group 2, 100-150 ng/mL, and group 3, >150 ng/mL), and gender.
A total of 282 932 patients who underwent 25(OH)D tests in our hospital were evaluated. A total of 1311 (0.5%) patients had very high 25(OH)D levels (>88 ng/mL). Four hundred and ninety-five patients who met our inclusion criteria and had complete data participated in the study. The median age was 58 years (interquartile range [IQR] = 41-71 years) and the median level of 25(OH)D was 104.6 mg/mL (IQR = 94.9-124.9 ng/mL). Most of the subjects (83.7%) with very high 25(OH)D levels were normocalcemic. A weak inverse correlation was observed between 25(OH)D level and intact parathyroid hormone (iPTH) level (r = -0.118, P = .01), but no correlation between 25(OH)D and calcium levels was observed. Alkaline phosphatase (ALP) levels were significantly higher in males (P = .032), and age and iPTH levels were higher in females (P < .001 and P = .004). ALP, phosphorus levels, and iPTH suppression rates were higher in hypercalcemic patients (P < .001, P < .001, and P < .001, respectively), while the iPTH level was significantly lower in hypercalcemic patients (P < .001) than in normocalcemic patients. Amongst the three groups with different 25(OH)D levels, no difference was found in levels of iPTH, calcium, phosphorus, ALP, or age.
Most patients with very high vitamin D levels were normocalcemic, but severe hypercalcemia was also observed. Vitamin D replacement therapy and follow-up should be performed according to clinical guideline recommendations.
评估 25-羟维生素 D（25（OH）D）水平极高的患者发生高钙血症的风险。
评估了 2014 年 1 月至 2018 年 12 月期间我院筛查 25（OH）D 的患者分布情况，并选择血清 25（OH）D 浓度>88ng/ml 的患者。然后，根据钙状态、维生素 D 水平（组 1，88-100ng/ml；组 2，100-150ng/ml，组 3，>150ng/ml）和性别比较 25（OH）D>88ng/ml 患者的生化参数。
在我院接受 25（OH）D 检测的 282932 例患者中，共有 1311 例（0.5%）患者 25（OH）D 水平极高（>88ng/ml）。符合纳入标准且资料完整的 495 例患者参与了研究。中位年龄为 58 岁（四分位距[IQR]=41-71 岁），中位 25（OH）D 水平为 104.6mg/ml（IQR=94.9-124.9ng/ml）。大多数（83.7%）25（OH）D 水平极高的患者血钙正常。25（OH）D 水平与完整甲状旁腺激素（iPTH）水平呈弱负相关（r=-0.118，P=0.01），但与钙水平无相关性。男性碱性磷酸酶（ALP）水平明显升高（P=0.032），女性年龄和 iPTH 水平较高（P<0.001 和 P=0.004）。高钙血症患者的 ALP、磷水平和 iPTH 抑制率均较高（P<0.001，P<0.001 和 P<0.001），而高钙血症患者的 iPTH 水平明显低于血钙正常患者（P<0.001）。在不同 25（OH）D 水平的三组中，iPTH、钙、磷、ALP 或年龄无差异。
大多数 25（OH）D 水平极高的患者血钙正常，但也观察到严重高钙血症。应根据临床指南建议进行维生素 D 替代治疗和随访。
