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A 43-year-old male asked:

could a severe vitamin d deficiency mask primary hyperparathyroidism by lowering serum calcium levels? [would u see low-normal calcium and high pth?]

3 doctor answers6 doctors weighed in
Dr. Philip Kern
Endocrinology 43 years experience
Primary hyperpara: Low vit d is common in patients with primary hyperparathyroidism. Although it is possible that it can mask the hypercalcemia, usually it does not. If your d is low, and you have hyperpara, you will likely still have a high ca. The low d may make the PTH level even higher, and vit d supplements should be given and they will not exacerbate the high calcium. This is complex. See endocrinologist.
Dr. Jack Rubin
Nephrology and Dialysis 48 years experience
Calcium and PTH: Hypercalcemia (h) due to hyperparathyroidism (ht) is due to parathyroid hormone (PTH) liberating calcium (c) from bone. Vit d allows the transport of c through the intestine to the blood. As vit. D inhibits PTH secretion, its lack would make PTH levels higher, causing worse h. If you think you have ht, get a pth, c and phosphate (p) level. High c, PTH and low p serum values are diagnostic for ht.
Dr. Brendan Stack jr., md, facs, face
Head and Neck Surgery 32 years experience
Masking: Masking of hyperpara with low D is unusual. 40% of hyperpara patients present with vitamin D deficiency. It is important to get all labs checked at the same time (blood draw) to prevent confounding results from tine of day or day to day changes. The labs I check are: total calcium, ionized calcium, 25 OH vitamin D, magnesium, phosphorus, creatinine, chloride, and intact PTH.

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Last updated Apr 29, 2019
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