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Characterization of vitamin D metabolism in active acromegaly in the setting of bolus (150,000 IU) cholecalciferol treatment

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Abstract

Purpose

To reveal distinctive features of vitamin D metabolism in patients with active acromegaly compared to healthy individuals, particularly in the setting of cholecalciferol treatment.

Methods

The study group included 34 adults with active acromegaly, and the control group included 30 apparently healthy adults with similar age, sex, and BMI. All participants received a single dose (150,000 IU) of cholecalciferol aqueous solution orally. Laboratory assessments including serum vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3), free 25(OH)D, vitamin D-binding protein (DBP) and parathyroid hormone (PTH) as well as serum and urine biochemical parameters were performed before the intake and on Days 1, 3, and 7 after the administration. All data were analyzed with nonparametric statistics.

Results

Patients with acromegaly had tendency to lower baseline 25(OH)D3 levels (p = 0.05) and lower 25(OH)D3 levels (p < 0.05) during the follow-up. They were also characterized by PTH suppression (lower baseline PTH levels and lower prevalence of secondary hyperparathyroidism), altered production of main vitamin D metabolites (higher 1,25(OH)2D3 and lower 24,25(OH)2D3 levels with corresponding lower 25(ОН)D3/1,25(ОН)2D3 and higher 25(ОН)D3/24,25(ОН)2D3 ratios) as well as concordant biochemical features (higher levels of serum phosphorus and albumin-adjusted calcium levels) throughout the study (p < 0.05). The acromegaly group showed an increase in DBP levels after cholecalciferol intake as opposed to the control group (p < 0.05) and had lower increase in free 25(OH)D levels (p < 0.05). Δ25(OH)D3 was similar between the groups (p > 0.05), showed a negative correlation with the disease activity markers—both IGF-1 levels (r = −0.44, p < 0.05) and fasting GH levels (r = −0.56, p < 0.05)—and lacked correlation with BMI in the acromegaly group (p > 0.05).

Conclusion

Patients with active acromegaly have dysregulated vitamin D metabolism characterized by higher 1,25(ОН)2D3, lower 24,25(ОН)2D3 and altered DBP production. The response to vitamin D supplementation in acromegaly patients might be influenced by hormonal excess. Obtained results require reproducibility check and further study to develop specific clinical recommendations.

Trial registration

NCT04844164 (release date: April 9, 2021; retrospectively registered).

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We express our deep gratitude to our colleagues: Zhanna Y. Belaya for the help in recruiting patients, Natalya M. Malysheva, Vitaliy A. Ioutsi, and Larisa V. Nikankina for the help with the laboratory research.

Funding

This research was funded by the Russian Science Foundation, grant number 19-15-00243.

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Authors and Affiliations

  1. Endocrinology Research Centre, 11, Dmitriya Ul’yanova street, Moscow, 117036, Russia

    Alexandra A. Povaliaeva, Viktor P. Bogdanov, Artem Yu. Zhukov, Ekaterina A. Pigarova, Larisa K. Dzeranova, Liudmila Ya. Rozhinskaya, Galina A. Mel’nichenko & Natalia G. Mokrysheva

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  1. Alexandra A. Povaliaeva
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  2. Viktor P. Bogdanov
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  3. Artem Yu. Zhukov
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  4. Ekaterina A. Pigarova
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  5. Larisa K. Dzeranova
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  8. Natalia G. Mokrysheva
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Correspondence to Alexandra A. Povaliaeva.

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The authors declare no competing interests.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Endocrinology Research Center, Moscow, Russia on April 10, 2019 (abstract of record No. 6). Informed consent was obtained from all individual participants included in the study.

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Povaliaeva, A.A., Bogdanov, V.P., Zhukov, A.Y. et al. Characterization of vitamin D metabolism in active acromegaly in the setting of bolus (150,000 IU) cholecalciferol treatment. Endocrine 76, 407–418 (2022). https://doi.org/10.1007/s12020-022-02994-0

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