Differences in the Clinical Presentation and Biochemical Profile of the Patients with Primary Hyperparathyroidism with regard to their Serum Vitamin D Levels: a Single-center Experience
Tóm tắt
The association between vitamin D deficiency and primary hyperparathyroidism (PHPT) is common and has clear implications. Vitamin D deficiency is commonly seen in PHPT population and exacerbates its severity with skeletal and metabolic effects. Retrospective data collection and review were done in patients who underwent surgery for PHPT at a tertiary care hospital in India between January 2011 and December 2020. A total of 150 subjects were included in the study and were divided into group 1 (vitamin D < 20 ng/ml, deficient), group 2 (vitamin D 21–29 ng/ml, insufficient), and group 3 (vitamin D > 30 ng/ml, sufficient). There was no difference in the duration of symptoms or the symptomatology between the three groups. Mean pre-operative serum calcium and serum phosphorous levels were also comparable in all the three groups. Mean pre-operative parathyroid hormone (PTH) levels in the three groups were 703 ± 996 vs 343.6 ± 396 vs 343.6 ± 396 pg/ml, respectively (P = 0.009). There was a statistically significant difference in group 1 vs groups 2 and 3 in their mean weight of the parathyroid gland (P = 0.018) and high alkaline phosphatase (ALP) levels (P = 0.047). Post-operative symptomatic hypocalcemia was observed in 17.3% of patients. Post-operative hungry bone syndrome occurred in 4 patients, all in group 1. PHPT in patients with low serum vitamin D was associated with higher serum PTH levels, increased frequency of high serum ALP levels, and higher weight of the excised gland, with no difference in the serum calcium and phosphorous.
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Misgar RA, Dar PM, Masoodi SR, Ahmad M, Wani KA, Wani AI et al (2016) Clinical and laboratory profile of primary hyperparathyroidism in Kashmir Valley: a single-center experience. Indian J Endocrinol Metab 20(5):696–701. https://doi.org/10.4103/2230-8210.190560
Ritu G, Gupta A (2014) Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients 6(2):729–75. https://doi.org/10.3390/nu6020729
Bhansali A, Masoodi SR, Reddy KS, Behera A, das Radotra B, Mittal BR et al (2005) Primary hyperparathyroidism in north India: a description of 52 cases. Ann Saudi Med 25(1):29–35. https://doi.org/10.5144/02564947.2005.29
Sarma D, Saikia UK, Appaiah S (2019) Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience. Int J Res Med Sci 7(4):1215–1221. https://doi.org/10.18203/2320-6012.ijrms20191328
Priya G, Jyotsna VP, Gupta N, Chumber S, Bal CS, Karak AK et al (2008) Clinical and laboratory profile of primary hyperparathyroidism in India. Postgrad Med J 84(987):34–39
Clements MR, Davies M, Fraser DR et al (1987) Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism. Clin Sci (London, England : 1979) 73(6):659–664. https://doi.org/10.1042/cs0730659
Eastell R, Brandi ML, Costa AG, D’Amour P, Shoback DM, Thakker RV (2014) Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99(10):3570–3579. https://doi.org/10.1210/jc.2014-1414
Pradeep PV, Jayashree B, Mishra A, Mishra SK (2011) Systematic review of primary hyperparathyroidism in India: the past, present, and the future trends. Int J Endocrinol 2011:921814. https://doi.org/10.1155/2011/921814
Witteveen JE, van Thiel S, Romijn JA, Hamdy NA (2013) Hungry bone syndrome: still a challenge in the postoperative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol 168(3):R45-53. https://doi.org/10.1530/EJE-12-0528
Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS et al (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res 21(171–177):3
Bilezikian JP, Silverberg SJ (2004) Asymptomatic primary hyperparathyroidism. N Engl J Med 350(17):1746–1751
Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VC, Bilezikian JP (2014) Bone disease in primary hyperparathyroidism. Arq Bras Endocrinol Metabol 58(5):553–561. https://doi.org/10.1590/00042730000003381
Castellano E, Attanasio R, Boriano A, Borretta G (2018) The clinical presentation of primary hyperparathyroidism: a southern European perspective over the last 2 decades. Endocr Pract 24(12):1023–1029
Bhadada SK, Arya AK, Mukhopadhyay S, Khadgawat R, Sukumar S, Lodha S et al (2018) Primary hyperparathyroidism: insights from the Indian PHPT registry. J Bone Miner Metab 36(2):238–245. https://doi.org/10.1007/s00774-017-0833-8
Gopal RA, Acharya SV, Bandgar T, Menon PS, Marfatia H, Shah NS (2009) Clinical profile of ectopic thyroid in Asian Indians: a single-center experience. Endocr Pract 15(4):322–325. https://doi.org/10.4158/EP08362.ORR1
Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J (2001) Unique clinical characteristics of primary hyperparathyroidism in India. J Br Surg 88(5):708–714
Harinarayan CV, Gupta N, Kochupillai N (1995) Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol 43(3):351–358
Dar PMUD, Malik LA, Wani AA, Kaur S, Wani SM, Wani MA et al (2020) Characteristics, management and outcome of primary hyperparathyroidism in a predominantly vitamin D deficient population: a single-center experience. Hellenic J Surg 92:7–12
Bandeira F, Caldas G, Freese E, Griz L, Faria M, Bandeira C (2002) Relationship between serum vitamin D status and clinical manifestations of primary hyperparathyroidism. Endocr Pract 8(4):266–270
Özbey N, Erbil Y, Ademoğlu E, Özarmağan S, Barbaros U, Bozbora A (2006) Correlations between vitamin D status and biochemical/clinical and pathological parameters in primary hyperparathyroidism. World J Surg 30(3):321–326
Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR et al (2000) Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 85(3):1054–1058. https://doi.org/10.1210/jcem.85.3.6440
Stewart ZA, Blackford A, Somervell H et al (2005) 5-Hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy. Surgery 138:1018–1026
Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ, Silverberg SJ (2015) Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation. J Clin Endocrinol Metab 100(9):3443–3451. https://doi.org/10.1210/jc.2015-2022
Ramas A, Jakubovic-Cičkisic A, Umihanic S, Sulejmanovic M, Brkic F (2019) Correlation between the parathyroid glands size and parathormones value in patients with hyperparathyroidism. Medical Archives 73(4):249