VITAMIN D VALUE IN DIAGNOSIS AND TREATMENT OF HYPERPARATHYROIDISM

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Abstract

Background: Pathophysiologic interaction between vitamin D and hyperparathyroidism (HPT) is under investigation, never being systematically studied and remaining incompletely understood till now. Aim: To define the effect of vitamin D insufficiency/deficiency on the clinical course of HPT as well as on the pre- and postoperative periods in patients with primary HPT. Materials and methods: Definition of vitamin D level, a test with alfacalcidol, and a fine-needle aspiration punction biopsy together with determination of parathyroid hormone (PTH) level in the needle lavage were included into the laboratory and instrumental examination of 374 patients with increased PTH level. Results: Definition of the vitamin D level gives a chance to differentiate between a mild form of primary HPT and secondary HPT in patients with vitamin D insufficiency/deficiency. Information on the vitamin D insufficiency/deficiency in primary HPT patients at the pre-surgical stage allows to forecast significant decrease in the ionized calcium level in the postoperative period. Conclusion: Definition of vitamin D level is a necessary component of laboratory diagnostics in all patients with a raised PTH level. Every patient with normocalcemia, normocalciuria and increased PTH level should undergo verification of HPT using the test with alfacalcidol. Normocalcemic variant of primary HPT is due to the vitamin D insufficiency/deficiency. The vitamin D insufficiency/deficiency, defined in patients at the pre-surgical stage, gives an opportunity to suggest a significant decrease in the serum ionized calcium level after parathyroidectomy and to start in time an oral treatment of hypocalcemia, providing differentiation between primary HPT recurrence and vitamin D insufficiency/deficiency in postoperative period, thereby avoiding additional observation and unjustified repeated operations.

About the authors

S. N. Pamputis

Yaroslavl State Medical Academy (YSMA); 5 Revolyutsionnaya ul., Yaroslavl, 150000, Russian Federation

Author for correspondence.
Email: pamputis@yandex.ru
MD, PhD, Assistant Professor, the Chair of Surgical Diseases, Pediatric Faculty, YSMA Russian Federation

Yu. K. Alexandrov

Yaroslavl State Medical Academy (YSMA); 5 Revolyutsionnaya ul., Yaroslavl, 150000, Russian Federation

Email: fake@neicon.ru
MD, PhD, Professor, Head of the Chair of Surgical Diseases, Pediatric Faculty, YSMA Russian Federation

E. N. Lopatnikova

Yaroslavl State Medical Academy (YSMA); 5 Revolyutsionnaya ul., Yaroslavl, 150000, Russian Federation

Email: fake@neicon.ru

MD, PhD, Assistant Professor, the Chair of Therapy, Pediatric Faculty, YSMA

Russian Federation

References

  1. Дедов ИИ, Мазурина НВ, Огнева НА, Трошина ЕА, Рожинская ЛЯ. Нарушения метаболизма витамина D при ожирении. Ожирение и метаболизм 2011;(2):3-10. (Dedov II, Mazurina NV, Ogneva NA, Troshina EA, Rozhinskaya LYa. [Vitamin D metabolic disorders in obesity]. Ozhirenie i metabolizm. 2011;(2):3-10. Russian).
  2. Рожинская ЛЯ. Современные представления об этиологии, патогенезе, клинической картине, диагностике и лечении первичного гиперпаратиреоза. Лечащий врач. 2009;(3):22-7. (Rozhinskaya LYa. [Contemporary views on etiology, pathogenesis, clinical picture, diagnosis, and treatment of primary hyperparathyroidism]. Lechashchiy vrach. 2009;(3):22-7. Russian).
  3. Спиричев ВБ, Громова ОА. Витамин D и его синергисты. Земский врач. 2012;(2):33-8. (Spirichev VB, Gromova OA. [Vitamin D and its synergists]. Zemskiy vrach. 2012;(2):33-8. Russian).
  4. Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, Feldman BS, Pan A, Johnson L, Crowe F, Hu FB, Franco OH. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.
  5. Finkelmeier F, Kronenberger B, Köberle V, Bojunga J, Zeuzem S, Trojan J, Piiper A, Waidmann O. Severe 25-hydroxyvitamin D deficiency identifies a poor prognosis in patients with hepatocellular carcinoma – a prospective cohort study. Aliment Pharmacol Ther. 2014;39(10):1204-12.
  6. Garg MK. The intestinal calcistat. Indian J Endocrinol Metab. 2013;17(Suppl1):S25-S28.
  7. Hill TR, Aspray TJ, Francis RM. Vitamin D and bone health outcomes in older age. Proc Nutr Soc. 2013;72(4):372-80.
  8. Nordenström E, Sitges-Serra A, Sancho JJ, Thier M, Almquist M. Vitamin D status in patients operated for primary hyperparathyroidism: comparison of patients from Southern and Northern Europe. Int J Endocrinol. 2013:164939.
  9. Rastogi A, Bhadada SK, Bhansali A. Pseudoarthrosis and fracture: interaction between severe vitamin D deficiency and primary hyperparathyroidism. Singapore Med J. 2013;54(11):e224-7.
  10. Rathi MS, Gonzalez S, Wright D, Ellis NR, Peacey SR. Management of hypovitaminosis D in patients with primary hyper-parathyroidism. J Endocrinol Invest. 2014. [In print].
  11. Resmini G, Tarantino U, Iolascon G. Vitamin D: role and opportunity to prescribe. Aging Clin Exp Res. 2013;25 Suppl 1: S125-7.
  12. Schoenmakers I, Francis RM, McColl E, Chadwick T, Goldberg GR, Harle C, Yarnall A, Wilkinson J, Parker J, Prentice A, Aspray T. Vitamin D supplementation in older people (VDOP): Study protocol for a randomised controlled intervention trial with monthly oral dosing with 12,000 IU, 24,000 IU or 48,000 IU of vitamin D₃. Trials. 2013;14:299.
  13. Schöttker B, Saum KU, Perna L, Ordóñez-Mena JM, Holleczek B, Brenner H. Is vitamin D deficiency a cause of increased morbidity and mortality at older age or simply an indicator of poor health? Eur J Epidemiol. 2014;29(3):199-210.
  14. Shriraam V, Mahadevan S, Anitharani M, Selvavinayagam, Sathiyasekaran B. National health programs in the field of endocrinology and metabolism – Miles to go. Indian J Endocrinol Metab. 2014;18(1):7-12.
  15. Soskić S, Stokić E, Isenović ER. The relationship between vitamin D and obesity. Curr Med Res Opin. 2014;30(6):1197-9.
  16. Toriola AT, Nguyen N, Scheitler-Ring K, Colditz GA. Circulating 25-hydroxyvitamin D levels and prognosis among cancer patients: a systematic review. Cancer Epidemiol Biomarkers Prev. 2014;23(6):917-933.
  17. Walker MD, Cong E, Kepley A, Di Tullio MR, Rundek T, Homma S, Lee JA, Liu R, Young P, Zhang C, McMahon DJ, Silverberg SJ. Association between serum 25-hydroxyvitamin D level and subclinical cardiovascular disease in primary hyperparathyroidism. J Clin Endocrinol Metab. 2014;99(2):671-80.

Copyright (c) 2014 Pamputis S.N., Alexandrov Y.K., Lopatnikova E.N.

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