Test Id : DHVD
1,25-Dihydroxyvitamin D, Serum
Useful For
Suggests clinical disorders or settings where the test may be helpful
As a second-order test in the assessment of vitamin D status, especially in patients with renal disease
Investigation of some patients with clinical evidence of vitamin D deficiency (eg, vitamin D-dependent rickets due to hereditary deficiency of renal 1-alpha hydroxylase or end-organ resistance to 1,25-dihydroxyvitamin D)
Differential diagnosis of hypercalcemia
Method Name
A short description of the method used to perform the test
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
1,25-Dihydroxy Vitamin D
1,25-Dihydroxycholecalciferol
1,25-Dihydroxyvitamin D3
Calcitriol
Specimen Type
Describes the specimen type validated for testing
Serum
Ordering Guidance
The 25-hydroxyvitamin D test (25HDN / 25-Hydroxyvitamin D2 and D3, Serum) in serum is the preferred initial test for assessing vitamin D status and most accurately reflects the body's vitamin D stores. In the presence of renal disease or hypercalcemia, testing of 1,25-dihydroxy vitamin D (DHVD) may be needed to adequately assess vitamin D status.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation:
Fasting: 4 hours, preferred but not required
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 1.5 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-General Request (T239)
-Renal Diagnostics Test Request (T830)
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.7 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 30 days | |
| Ambient | 7 days | ||
| Frozen | 30 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
As a second-order test in the assessment of vitamin D status, especially in patients with renal disease
Investigation of some patients with clinical evidence of vitamin D deficiency (eg, vitamin D-dependent rickets due to hereditary deficiency of renal 1-alpha hydroxylase or end-organ resistance to 1,25-dihydroxyvitamin D)
Differential diagnosis of hypercalcemia
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Vitamin D is a generic designation for a group of fat-soluble, structurally similar sterols, which act as hormones. In the presence of renal disease or hypercalcemia, testing of 1,25-dihydroxy vitamin D (DHVD) may be needed to adequately assess vitamin D status. The 25-hydroxyvitamin D (25HDN) test (25HDN / 25-Hydroxyvitamin D2 and D3, Serum) in serum is otherwise the preferred initial test for assessing vitamin D status and most accurately reflects the body's vitamin D stores.
Vitamin D compounds in the body are exogenously derived by dietary means from plants as 25-hydroxyvitamin D2 (ergocalciferol or calciferol) or from animal products as 25-hydroxyvitamin D3 (cholecalciferol or calcidiol). Vitamin D may also be endogenously derived by conversion of 7-dihydrocholesterol to 25-hydroxyvitamin D3 in the skin upon ultraviolet exposure.
The 25-hydroxyvitamin D is subsequently formed by hydroxylation by CYP2R1 in the liver. 25HDN is a prohormone that represents the main reservoir and transport form of vitamin D, being stored in adipose tissue and tightly bound by a transport protein while in circulation. Biological activity is expressed in the form of DHVD, the active metabolite of 25HDN. 1-Alpha-hydroxylation by CYP27B1 occurs on demand, primarily in the kidneys, under the control of parathyroid hormone (PTH) before expressing biological activity. Like other steroid hormones, DHVD binds to a nuclear receptor, influencing gene transcription patterns in target organs.
25-hydroxyvitamin D may also be converted into the inactive metabolite 24,25-dihydroxyvitamin D (24,25D) by alternative hydroxylation by CYP24A1. This process, regulated by PTH, might increase DHVD synthesis at the expense of the alternative CYP24A1 hydroxylation product 24,25D. Inactivation of 25HDN and DHVD by CYP24A1 is a crucial process that prevents over production of DHVD and resultant vitamin D toxicity.
1,25-dihydroxy vitamin D stimulates calcium absorption in the intestine and its production is tightly regulated through concentrations of serum calcium, phosphorus, and PTH. DHVD promotes intestinal calcium absorption and, in concert with PTH, skeletal calcium deposition or, less commonly, calcium mobilization. Renal calcium and phosphate reabsorption are also promoted, while prepro-PTH mRNA expression in the parathyroid glands is downregulated. The net result is a positive calcium balance, increasing serum calcium and phosphate levels, and falling PTH concentrations.
In addition to its effects on calcium and bone metabolism, DHVD regulates the expression of a multitude of genes in many other tissues including immune cells, muscle, vasculature, and reproductive organs.
1,25-dihydroxy vitamin D levels are decreased in hypoparathyroidism and in chronic renal failure. DHVD levels may be high in primary hyperparathyroidism and in physiologic hyperparathyroidism secondary to low calcium or vitamin D intake. Some patients with granulomatous diseases (eg, sarcoidosis) and malignancies containing nonregulated 1-alpha hydroxylase in the lesion might have hypercalcemia that appears vitamin D mediated with normal or high serum phosphate (hyperphosphatemia) and hypercalcemia (both of which might be severe) in addition to low PTH and absent parathyroid hormone-related peptide (PTHRP). Assessment of 24,25D might also be required in patients with hypercalcemia that does not appear to be driven by PTH or PTHRP and may be helpful in assessment of patients with loss of function inactivating CYP24A1 mutations. Differential diagnostic considerations include vitamin D intoxication and CYP24A1 deficiency.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Males:
<16 years: 24-86 pg/mL
> or =16 years: 18-64 pg/mL
Females:
<16 years: 24-86 pg/mL
> or =16 years: 18-78 pg/mL
For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Interpretation
Provides information to assist in interpretation of the test results
1,25-Dihydroxyvitamin D (DVHD) concentrations are low in chronic renal failure and hypoparathyroidism.
1,25-Dihydroxyvitamin D concentrations are high in sarcoidosis and other granulomatous diseases, some malignancies, primary hyperparathyroidism, and physiologic hyperparathyroidism.
1,25-Dihydroxyvitamin D concentrations are not a reliable indicator of vitamin D toxicity; normal (or even low) results may be seen in such cases.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements.
Supportive Data
The 1,25-dihydroxyvitamin D liquid chromatography tandem mass spectrometry (LC-MS/MS) assay correlates well with the current immunoassay:
-LC-MS/MS=0.95 RIA (pg/mL) + 2.5 pg/mL; correlation coefficient=0.822
-Inter-assay precision: 7 to 12% CV (19 to 287 pg/mL)
-Interferences: C-3 epimers (EPI) of 1,25 dihydroxyvitamin D3 3.0%
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Endres DB, Rude RK. Vitamin D and its metabolites. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 3rd ed. WB Saunders Company, 1999:1417-1423
2. Bringhurst FR, Demay MB, Kronenberg HM. Vitamin D (calciferols): metabolism of vitamin D. In: Wilson JD, Foster DS, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology. 9th ed. 1998:1166-1169
3. Laha TJ, Strathmann FG, Wang Z, de Boer IH, Thummel KE, Hoofnagle AN. Characterizing antibody cross-reactivity for immunoaffinity purification of analytes prior to multiplexed liquid chromatography-tandem mass spectrometry. Clin Chem. 2012;58(12):1711-1716. doi:10.1373/clinchem.2012.185827
4. Strathmann FG, Laha TJ, Hoofnagle AN. Quantification of 1a,25-dihydroxy vitamin D by immunoextraction and liquid chromatography-tandem mass spectrometry. Clin Chem. 2011;57(9):1279-1285. doi:10.1373/clinchem.2010.161174
5. Herrmann M. Assessing vitamin D metabolism - four decades of experience. Clin Chem Lab Med. 2023;61(5):880-894. doi:10.1515/cclm-2022-1267
Method Description
Describes how the test is performed and provides a method-specific reference
Deuterated stable isotopes are added to sample as internal standard. 1,25-Dihydroxyvitamin D and the internal standard are extracted. The extracts are then further purified by solid phase extraction (SPE) and affinity extraction. Extracts are then derivatized and analyzed by chromatography-tandem mass spectrometry using multiple reaction monitoring.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
82652
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| DHVD | 1,25-Dihydroxyvitamin D, S | 62290-2 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 8822 | 1,25-Dihydroxyvitamin D, S | 62290-2 |