title: 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.
abstract: 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<0.0001). Resected parathyroid tumors were larger in size in group A patients (p=0.01), and weighed more (p=0.01). There was a positive correlation between the weight of the parathyroid tumor and the PTH index (p=0.002), and AP level (p=0.0007). We concluded that vitamin D deficiency is a contributing factor to both the severity of bone disease and the high activity of parathyroid tumors seen in many patients with pHPT in vitamin D deficient regions.
authors.affiliation: Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. hraef@kfshrc.edu.sa
authors.forename: H
authors.initials: H
authors.lastname: Raef
authors.forename: S
authors.initials: S
authors.lastname: Ingemansson
authors.forename: S
authors.initials: S
authors.lastname: Sobhi
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: M
authors.initials: M
authors.lastname: Ahmed
authors.forename: M
authors.initials: M
authors.lastname: Chaudhry
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000150:complications*; D006965:Hyperplasia; D006996:Hypocalcemia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood* / Q000150:complications*
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase