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Vitamin D Metabolite Concentrations in Vitamin D Deficiency: Are Calcitriol Levels Normal?

Vitamin D Metabolite Concentrations in Vitamin D Deficiency: Are Calcitriol Levels Normal? Abstract • The levels of vitamin D metabolites were measured in three children with a decreased dietary intake of calcium and vitamin D and sun exposure. All three children had hypocalcemia, hypophosphatemia, and elevated alkaline phosphatase activities. Two children had rickets, aminoaciduria, and elevated immunoreactive parathyroid hormone (iPTH) concentrations. The concentrations of vitamins D2 and D3, 25-hydroxyvitamins D2 and D3 (25-OH-D2 and 25-OH-D3), and 24,25-dihydroxyvitamin D (24,25-[OH]2D) were reduced. Nonetheless, the levels of calcitriol (1,25-[OH]2D) were normal. The combination of hypocalcemia, hypophosphatemia, and increased iPTH concentrations should result in supranormal calcitriol concentrations. Moreover, the ratio of PTH to calcitriol is significantly higher than in normal subjects. Accordingly, in patients with vitamin D deficiency and "normal" calcitriol values, the synthesis of this compound may be reduced. The evaluation of vitamin D deficiency should include the measurement of all metabolites. (Am J Dis Child 1981;135:1025-1028) References 1. DeLuca HF: The vitamin D system in the regulation of calcium and phosphorus metabolism . Nutr Rev 1979;37:161-193.Crossref 2. Shepard RM, Horst RL, Hamstra AJ, et al: Determination of vitamin D and its metabolites in plasma from normal and anephric man . Biochem J 1979;182:55-69. 3. Chesney RW, Rosen JF, Hamstra AJ, et al: Serum 1,25-dihydroxyvitamin D levels in normal children and in vitamin D disorders . Am J Dis Child 1980;134:135-139.Crossref 4. Eastwood JB, DeWardener HE, Gray RW, et al: Normal plasma-1,25(OH)2-vitamin D concentrations is nutritional osteomalacia . Lancet 1979;1:1377-1378.Crossref 5. Nguyen TM, Guillozo H, Garabedian M, et al: Serum concentration of 24,25-dihydroxyvitamin D in normal children and in children with rickets . Pediatr Res 1979;13:973-976.Crossref 6. Rasmussen H, Baron R, Broadus A, et al: 1,25(OH)2D3 is not the only D metabolite involved in the pathogenesis of osteomalacia . Am J Med 1980;69:360-368.Crossref 7. Papapoulos SE, Clemens TL, Fraher LJ, et al: Metabolites of vitamin D in human vitamin D deficiency: Effect of vitamin D, or 1,25-dihydroxycholecalciferol . Lancet 1980;2:612-615.Crossref 8. Chesney RW, Hamstra AJ, DeLuca HF: Rickets of prematurity: Supranormal levels of serum 1,25-dihydroxyvitamin D . Am J Dis Child 1981;135:34-37.Crossref 9. Steichen JJ, Ho M, Hug G, et al: Elevated serum 1,25(OH)2-vitamin D concentrations in rickets of prematurity . Pediatr Res 1980;14:581. 10. Chesney RW, Mazess RB, Rose PG: Bone mineral status measured by direct photon absorptiometry in childhood renal disease . Pediatrics 1977;60:864-873. 11. Jubiz W, Hanssler MR, McCain TA, et al: Plasma 1,25-dihydroxyvitamin D levels in patients receiving anticonvulsant drugs . J Clin Endocrinol Metab 1977;44:617-623.Crossref 12. Halloran BP, DeLuca HF: Vitamin D deficiency and reproduction in rats . Science 1979; 204;73-74.Crossref 13. Levin ME, Boisseau VC, Avioli LV: Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes . N Engl J Med 1976; 294:241.Crossref 14. McNair P, Madsbad S, Christensen MS: Bone mineral loss in insulin-treated diabetes mellitus: Studies on pathogenesis . Acta Endocrinol 1979;90:463. 15. Shore RM, Chesney RW, Mazess RB, et al: Osteopenia in juvenile diabetes. Calcif Tissue Int, to be published. 16. Shires R, Teitelbaum SL, Bergfeld MA, et al: The effect of streptozotocin-induced chronic diabetes mellitus on bone and mineral homeostasis in the rat. J Lab Clin Med, to be published. 17. Gertner JM, Tamborlane WV, Horst RL, et al: Mineral metabolism in diabetes mellitus: Changes accompanying treatment with a portable subcutaneous insulin infusion system . J Clin Endocrinol Metab 1980;50:862-866.Crossref 18. Tanaka Y, Lorenc RS, DeLuca HF: The role of 1,25-dihydroxyvitamin D3 and parathyroid hormone in the regulation of chick renal 25-hydroxyvitamin D3-24-hydroxylase . Arch Biochem Biophys 1975;171:521-526.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Vitamin D Metabolite Concentrations in Vitamin D Deficiency: Are Calcitriol Levels Normal?

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References (16)

Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1981.02130350029010
Publisher site
See Article on Publisher Site

Abstract

Abstract • The levels of vitamin D metabolites were measured in three children with a decreased dietary intake of calcium and vitamin D and sun exposure. All three children had hypocalcemia, hypophosphatemia, and elevated alkaline phosphatase activities. Two children had rickets, aminoaciduria, and elevated immunoreactive parathyroid hormone (iPTH) concentrations. The concentrations of vitamins D2 and D3, 25-hydroxyvitamins D2 and D3 (25-OH-D2 and 25-OH-D3), and 24,25-dihydroxyvitamin D (24,25-[OH]2D) were reduced. Nonetheless, the levels of calcitriol (1,25-[OH]2D) were normal. The combination of hypocalcemia, hypophosphatemia, and increased iPTH concentrations should result in supranormal calcitriol concentrations. Moreover, the ratio of PTH to calcitriol is significantly higher than in normal subjects. Accordingly, in patients with vitamin D deficiency and "normal" calcitriol values, the synthesis of this compound may be reduced. The evaluation of vitamin D deficiency should include the measurement of all metabolites. (Am J Dis Child 1981;135:1025-1028) References 1. DeLuca HF: The vitamin D system in the regulation of calcium and phosphorus metabolism . Nutr Rev 1979;37:161-193.Crossref 2. Shepard RM, Horst RL, Hamstra AJ, et al: Determination of vitamin D and its metabolites in plasma from normal and anephric man . Biochem J 1979;182:55-69. 3. Chesney RW, Rosen JF, Hamstra AJ, et al: Serum 1,25-dihydroxyvitamin D levels in normal children and in vitamin D disorders . Am J Dis Child 1980;134:135-139.Crossref 4. Eastwood JB, DeWardener HE, Gray RW, et al: Normal plasma-1,25(OH)2-vitamin D concentrations is nutritional osteomalacia . Lancet 1979;1:1377-1378.Crossref 5. Nguyen TM, Guillozo H, Garabedian M, et al: Serum concentration of 24,25-dihydroxyvitamin D in normal children and in children with rickets . Pediatr Res 1979;13:973-976.Crossref 6. Rasmussen H, Baron R, Broadus A, et al: 1,25(OH)2D3 is not the only D metabolite involved in the pathogenesis of osteomalacia . Am J Med 1980;69:360-368.Crossref 7. Papapoulos SE, Clemens TL, Fraher LJ, et al: Metabolites of vitamin D in human vitamin D deficiency: Effect of vitamin D, or 1,25-dihydroxycholecalciferol . Lancet 1980;2:612-615.Crossref 8. Chesney RW, Hamstra AJ, DeLuca HF: Rickets of prematurity: Supranormal levels of serum 1,25-dihydroxyvitamin D . Am J Dis Child 1981;135:34-37.Crossref 9. Steichen JJ, Ho M, Hug G, et al: Elevated serum 1,25(OH)2-vitamin D concentrations in rickets of prematurity . Pediatr Res 1980;14:581. 10. Chesney RW, Mazess RB, Rose PG: Bone mineral status measured by direct photon absorptiometry in childhood renal disease . Pediatrics 1977;60:864-873. 11. Jubiz W, Hanssler MR, McCain TA, et al: Plasma 1,25-dihydroxyvitamin D levels in patients receiving anticonvulsant drugs . J Clin Endocrinol Metab 1977;44:617-623.Crossref 12. Halloran BP, DeLuca HF: Vitamin D deficiency and reproduction in rats . Science 1979; 204;73-74.Crossref 13. Levin ME, Boisseau VC, Avioli LV: Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes . N Engl J Med 1976; 294:241.Crossref 14. McNair P, Madsbad S, Christensen MS: Bone mineral loss in insulin-treated diabetes mellitus: Studies on pathogenesis . Acta Endocrinol 1979;90:463. 15. Shore RM, Chesney RW, Mazess RB, et al: Osteopenia in juvenile diabetes. Calcif Tissue Int, to be published. 16. Shires R, Teitelbaum SL, Bergfeld MA, et al: The effect of streptozotocin-induced chronic diabetes mellitus on bone and mineral homeostasis in the rat. J Lab Clin Med, to be published. 17. Gertner JM, Tamborlane WV, Horst RL, et al: Mineral metabolism in diabetes mellitus: Changes accompanying treatment with a portable subcutaneous insulin infusion system . J Clin Endocrinol Metab 1980;50:862-866.Crossref 18. Tanaka Y, Lorenc RS, DeLuca HF: The role of 1,25-dihydroxyvitamin D3 and parathyroid hormone in the regulation of chick renal 25-hydroxyvitamin D3-24-hydroxylase . Arch Biochem Biophys 1975;171:521-526.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Nov 1, 1981

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