Plasma concentrations of vitamin D metabolites before and during treatment of vitamin D deficiency rickets in children

T Markestad, S Halvorsen, KS Halvorsen… - Acta …, 1984 - Wiley Online Library
T Markestad, S Halvorsen, KS Halvorsen, L Aksnes, D Aarskog
Acta Pædiatrica, 1984Wiley Online Library
Plasma concentrations of 25‐hydroxyvitamin D (25‐OHD), 1, 25‐dihydroxyvitamin D (1, 25‐
(OH) 2D), and 24, 25‐dihydroxyvitamin D (24, 25‐(OH) 2D) were determined in 17 children
with vitamin D deficiency rickets before therapy was started. Thirteen of them also had these
tests repeated during treatment. The median 25‐OHD concentration was at the lower limit of
the reference range before, but increased distinctly within one week of treatment with 1700–
4000 IU vitamin D per day (17 vs. 37 nmol/l, p< 0.01). 24, 25‐(OH) 2D was undetectable in …
Abstract
Plasma concentrations of 25‐hydroxyvitamin D (25‐OHD), 1,25‐dihydroxyvitamin D (1,25‐(OH)2D), and 24,25‐dihydroxyvitamin D (24,25‐(OH)2D) were determined in 17 children with vitamin D deficiency rickets before therapy was started. Thirteen of them also had these tests repeated during treatment. The median 25‐OHD concentration was at the lower limit of the reference range before, but increased distinctly within one week of treatment with 1700–4000 IU vitamin D per day (17 vs. 37 nmol/l, p < 0.01). 24,25‐(OH)2D was undetectable in twelve of the patients before therapy. Detectable concentrations were in the range of 1.7 to 3.5 % of the corresponding 25‐OHD levels throughout the study, and the two metabolites were closely correlated (r= 0.84, p < 0.0005). The median l,25‐(OH)2D concentration was near the average of the reference range before, but increased to well above the upper limit of normal within one week of treatment (121 vs. 368 pmol/l, p < 0.01). The levels were largely normal after 10 weeks of therapy, as were the plasma concentrations of calcium, phosphate, and alkaline phosphatase. Parathyroid activity, as judged by serum parathyroid hormone or urinary cyclic AMP concentrations, was stimulated in 11 of 12 children studied prior to treatment. It is concluded that there may be no clear‐cut differences between normal nad rachitic values of the different vitamin D metabolites under practical clinical conditions. A low 25‐OHD level combined with evidence of a stimulated parathyroid activity, and a rise of l,25‐(OH)2D levels to supernormal values following a few days of vitamin D therapy may be diagnostic clues.
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