Clinical and laboratory profile of primary hyperparathyroidism in India

Postgraduate Medical Journal - Tập 84 Số 987 - Trang 34-39 - 2008
Gagan Priya1, Viveka P. Jyotsna1, Neerja Gupta1, Sunil Chumber2, Chandrasekhar Bal1, A K Karak1, Anju Seth1, A C Ammini1
1Department of Endocrinology and Metabolism, AIIMS, New Delhi, India
2Department of Surgery, AIIMS, New Delhi, India

Tóm tắt

Abstract Aim To assess 25-hydroxyvitamin D (25OHD) concentrations in patients with primary hyperparathyroidism and to study the relationship, if any, between vitamin D concentration and bone disease. Methods Consecutive patients with diagnosed primary hyperparathyroidism were enrolled in the study. Clinical and biochemical details, including serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH) and 25OHD levels, were recorded. An abbreviated skeletal survey and preoperative localisation with ultrasound/CT scan of the neck and tetrofosmin/technetium-99m hexakis(2-methoxyisobutylisonitrile) parathyroid scan was performed. Results 39 patients with primary hyperparathyroidism were identified (mean (SD) age 38.4 (15.0) years (range 12–72)). The most common presenting features were bone pain (80%), fatigue (80%) and proximal muscle weakness (78%). Brown tumours were present in 58% of cases, renal calculi in 42% and nephrocalcinosis in 12%. The mean (SD) corrected serum calcium concentration was 12.47 (1.58) mg/dl (3.2 (0.4) mmol/l). Serum 25OHD concentration was <5 ng/ml in 11 patients (28%), 5–10 ng/ml in nine (23%), 10–20 ng/ml in 14 (36%), and >20 ng/ml in five (13%). Serum alkaline phosphatase, PTH and gland weight were higher, whereas serum 25OHD was lower, in patients with skeletal disease. Patients with 25OHD concentrations ⩽10 ng/ml had higher body mass index, lower postoperative calcium and higher postoperative PTH. There was a significant correlation between serum calcium and adenoma weight. Conclusion The profile of patients with diagnosed primary hyperparathyroidism does not seem to have changed over the last decade. Parathyroid gland weight was found to correlate with serum calcium and PTH.

Từ khóa


Tài liệu tham khảo

Bilezikian, 2005, Primary hyperparathyrodism: new concepts in clinical, densitometric and biochemical features, J Intern Med, 257, 6, 10.1111/j.1365-2796.2004.01422.x

Parafitt, 1994, The parathyroids: basic and clinical concepts, 373

Wermers, 1997, The rise and fall of primary hyperparathyrodism: a population-based study in Rochester, Minnesota, 1965–1992, Ann Intern Med, 126, 433, 10.7326/0003-4819-126-6-199703150-00003

Heath, 1980, Primary hyperparathyrodism. Incidence, morbidity and potential economic impact in a community, N Engl J Med, 302, 189, 10.1056/NEJM198001243020402

Cope, 1966, The study of hyperparathyroidism at the Massachusetts General Hospital, N Engl J Med, 274, 1174, 10.1056/NEJM196605262742105

Mallette, 1974, Primary hyperparathyroidism: clinical and biochemical features, Medicine (Baltimore), 53, 127, 10.1097/00005792-197403000-00002

Bilezikian, 1991, Characterization and evaluation of asymptomatic primary hyperparathyroidism, J Bone Miner Res, 6, S85, 10.1002/jbmr.5650061419

Kapur, 1985, Clinical & biochemical features of primary hyperparathyroidism, Indian J Med Res, 81, 607

Harinarayan, 1995, Vitamin D status in primary hyperparathyroidism in India, Clin Endocrinol (Oxf), 43, 351, 10.1111/j.1365-2265.1995.tb02043.x

Mishra, 2001, Unique clinical characteristics of primary hyperparathyroidism in India, Br J Surg, 88, 708, 10.1046/j.0007-1323.2001.01775.x

Bhansali, 2005, Primary hyperparathyroidism in North India: a description of 52 cases, Ann Saudi Med, 25, 29, 10.5144/0256-4947.2005.29

Dandona, 1984, Persistence of parathyroid hypersecretion after vitamin D treatment in Asian vegetarians, J Clin Endocrinol Metab, 59, 535, 10.1210/jcem-59-3-535

Henderson, 1990, Asian osteomalacia is determined by dietary factors when exposure to ultraviolet radiation is restricted: a risk factor model, Q J Med, 76, 923

Lamberg Allardt, 1993, Low serum 25 hydroxyvitamin D concentration and secondary hyperparathyroidism in middle-aged white strict vegetarians, Am J Clin Nutr, 58, 684, 10.1093/ajcn/58.5.684

Rao, 2000, Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications, J Clin Endocrinol Metab, 85, 1054

Moosgaard, 2005, Vitamin D status, seasonal variation, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism, Clin Endocrinol (Oxf), 63, 506, 10.1111/j.1365-2265.2005.02371.x

Silverberg, 1999, The effects of vitamin D insufficiency in patients with primary hyperparathyroidism, Am J Med, 107, 561, 10.1016/S0002-9343(99)00294-6

Yamashita, 2002, Vitamin D status in Japanese patients with hyperparathyroidism: seasonal changes and effect on clinical presentation, World J Surg, 26, 937, 10.1007/s00268-002-6622-z

Carnevale, 2004, Vitamin D status in female patients with primary hyperparathyroidism: does it play a role in skeletal damage?, Clin Endocrinol (Oxf), 60, 81, 10.1111/j.1365-2265.2004.01946.x

Ozbey, 2006, Correlations between vitamin D status and biochemical/clinical and pathological parameters in primary hyperparathyroidism, World J Surg, 30, 321, 10.1007/s00268-005-0239-y

Bandeira, 2002, Relationship between serum vitamin D status and clinical manifestations of primary hyperparathyroidism, Endocr Pract, 8, 266, 10.4158/EP.8.4.266

Lips, 2001, Vitamin D sufficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications, Endocr Rev, 22, 477, 10.1210/edrv.22.4.0437

Stewart, 2005, 25-hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy, Surgery, 138, 1018, 10.1016/j.surg.2005.09.018

Wang, 2005, Persistently elevated parathyroid hormone levels after parathyroid surgery, Surgery, 138, 1130, 10.1016/j.surg.2005.08.026

Bartos, 1965, Parathyroid hyperplasia in osteomalacia, J Clin Endocrinol Metab, 25, 1522, 10.1210/jcem-25-11-1522

Jones, 1998, Current understanding of the molecular actions of vitamin D, Physiol Rev, 78, 1193, 10.1152/physrev.1998.78.4.1193

Carling, 2001, Molecular pathology of parathyroid tumors, Trends Endocrinol Metab, 12, 53, 10.1016/S1043-2760(00)00345-3

Wynford-Thomas, 1983, Experimental induction of parathyroid adenomas in the rat, J Natl Cancer Inst, 70, 127

Stanbury, 1975, Asian rickets and osteomalacia: patterns of parathyroid response in vitamin D deficiency, Proc Nutr Soc, 34, 111, 10.1079/PNS19750021

Lumb, 1974, Parathyroid function in human vitamin D deficiency and vitamin D deficiency in primary hyperparathyroidism, Am J Med, 56, 833, 10.1016/0002-9343(74)90812-2

Woodhouse, 1971, Vitamin-D deficiency and primary hyperparathyroidism, Lancet, 2, 283, 10.1016/S0140-6736(71)91333-X

Dent, 1975, Masked primary (or tertiary) hyperparathyroidism, Lancet, 1, 1161, 10.1016/S0140-6736(75)93137-2

Thông tin
Thông tin xuất bản

Postgraduate Medical Journal

Tập 84 Số 987

34-39

Thông tin tác giả