<prompt> Raised calcium and phosphorus are seen in -CRFVitamin D intoxicationHyperparathyroidismpseudohypoparathyroidism  <response>: Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia.Hypercalcemia in vitamin D intoxication is due to an excessive biologic action of the vitamin, perhaps the consequence of increased levels of 25OHD rather than merely increased levels of the active metabolite 1,25OH 2 D the latter may not be elevated in vitamin D intoxication. 25OHD has definite, if low, biologic activity in the intestine and bone. The production of 25OHD is less tightly regulated than is the production of 1,25OH 2 D. Hence concentrations of 25OHD are elevated severalfold in patients with excess vitamin D intake. The diagnosis is substantiated by documenting elevated levels of 25OHD 100 mgmL. Hypercalcemia is usually controlled by restriction of dietary calcium intake and appropriate attention to hydration. These measures, plus discontinuation of vitamin D, usually lead to resolution of hypercalcemia. However, vitamin D stores in fat may be substantial, and vitamin D intoxication may persist for weeks after vitamin D ingestion is terminated. Such patients are responsive to glucocoicoids, which in doses of 100 mgd of hydrocoisone or its equivalent usually return serum calcium levels to normal over several days; severe intoxication may require intensive therapyharrison 18 pg 3108 