The effect of vitamin D status on the severity of bone disease and on the other features of primary hyperparathyroidism (pHPT) in a vitamin D deficient region

• Published in: Journal of endocrinological investigation 2004-10, Vol.27 (9), p.807-812
• Main Authors: Raef, H, Ingemansson, S, Sobhi, S, Sultan, A, Ahmed, M, Chaudhry, M
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - pathology; Adenoma - surgery; Adult; Aged; Alkaline Phosphatase - blood; Bone Diseases - diagnostic imaging; Bone Diseases - etiology; Female; Humans; Hyperparathyroidism - blood; Hyperparathyroidism - complications; Hyperplasia; Hypocalcemia - epidemiology; Hypocalcemia - etiology; Male; Middle Aged; Parathyroid Glands - pathology; Parathyroid Glands - surgery; Parathyroid Hormone - blood; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - pathology; Parathyroid Neoplasms - surgery; Parathyroidectomy - adverse effects; Prevalence; Radiography; Retrospective Studies; Severity of Illness Index; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications
• ISSN: 0391-4097; 1720-8386
• DOI: 10.1007/bf03346273

A clear relationship between vitamin D status and the clinical indices of primary hyperparathyroidism (pHPT) severity has not been convincingly established. We proposed that such a relationship might exist, in so far as vitamin D deficiency could contribute to the severity of metabolic bone disease and promote the growth of the parathyroid tumor. Accordingly, we undertook a retrospective study and analyzed the clinical, biochemical, radiological and histopathological findings in a group of 49 patients who underwent parathyroidectomy at our center. Patients who had skeletal X-rays were grouped, according to their X-ray findings, in group A (19 patients; 45%) if they had severe bone changes, or group B (23 patients; 55%) if they had mild or no bone changes. Patients were also stratified according to their 25-hydroxyvitamin D (25-OHD) levels in tertiles. The 2 groups were compared using Fisher's exact test or analysis of variance as appropriate. Group A patients were younger (p=0.001), had more musculoskeletal symptoms (p=0.0003), and complained more frequently of fatigue (p=0.02). They had higher alkaline phosphatase (AP; p=0.0002), PTH index (p=0.0007), and serum Ca level (p=0.006). There were more patients from the lower and middle vitamin D tertiles and fewer patients from the upper vitamin D tertile in group A (p=0.02). Post-operative severe hypo-calcemia was more prevalent in group A patients (p