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Are Calcitriol Levels Normal?

Russell W. Chesney, MD; Jerry Zimmerman, MD; Alan Hamstra; Hector F. DeLuca, PhD; Richard B. Mazess, PhD

Am J Dis Child. 1981;135(11):1025-1028.

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)

Author Affiliations
From the Departments of Pediatrics (Drs Chesney and Zimmerman), Biochemistry (Mr Hamstra and Dr DeLuca), and Radiology (Dr Mazess), University of Wisconsin, Madison.

Footnotes
Reprint requests to Department of Pediatrics, Clinical Sciences Center H4/452, 600 N Highland Ave, Madison, WI 53792 (Dr Chesney).

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