Zafer Pekkolay1, Dilek Gogas Yavuz2, Emre Sedar Saygılı3, Ceyla Konca Değertekin4, Ömercan Topaloğlu5, Çağatay Emir Önder6, Hikmet Soylu7, Işılay Taskaldıran6, Ayşe Esen Pazır8, Kader Uğur9, Seher Tanrıkulu10, Sevde Nur Fırat6, Burcu Meryem Atak11, Adnan Batman12, Tülay Omma6, Eylem Cağıltay13, Nilüfer Özdemir14, Seher Çetinkaya Altuntaş15, Narin Nasıroğlu İmga16, Ersen Karakılıç3, Zeliha Hekimsoy14, Faruk Kılınç9, Adnan Yay13, Mustafa Eroğlu17, Alpaslan Kemal Tuzcu18. 1. Department of Endocrinology, School of Medicine, Dicle University, Diyarbakır, Turkey. drpekkolay@gmail.com. 2. Department of Endocrinology, School of Medicine, Marmara University, İstanbul, Turkey. 3. Department of Endocrinology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey. 4. Deparment of Endocrinology, Ufuk University School of Medicine, Ankara, Turkey. 5. Department of Endocrinology, School of Medicine, Zonguldak Bülent Ecevit University, Kocaeli, Turkey. 6. Department of Endocrinology, Ankara Training and Research Hospital, Ankara, Turkey. 7. Gazi Yaşargil Training and Research Hospital, Endocrinology Clinic, Diyarbakır, Turkey. 8. Department of Endocrinology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey. 9. Department of Endocrinology, Fırat University School of Medicine, Elazığ, Turkey. 10. Department of Endocrinology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey. 11. Department of Endocrinology, School of Medicine, Akdeniz University, Antalya, Turkey. 12. Department of Endocrinology, Koç University, School of Medicine, İstanbul, Turkey. 13. Department of Endocrinology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, İstanbul, Turkey. 14. Department of Endocrinology, School of Medicine, Celal Bayar University, Manisa, Turkey. 15. Department of Endocrinology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey. 16. Deparment of Endocrinology, Ankara Numune Training and Research Hospital, Ankara, Turkey. 17. Department of Endocrinology, School of Medicine, Balıkesir University, Balıkesir, Turkey. 18. Department of Endocrinology, School of Medicine, Dicle University, Diyarbakır, Turkey.
Abstract
Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. PURPOSE: We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. METHODS: An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. RESULTS: A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. CONCLUSIONS: High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.
Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. PURPOSE: We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. METHODS: An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. RESULTS: A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. CONCLUSIONS: High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.
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