Impact of 25-hydroxyvitamin D deficiency on perioperative parathyroid hormone kinetics and results in patients with primary hyperparathyroidism.
BACKGROUND
Successful parathyroidectomy for sporadic primary hyperparathyroidism (pHPT) is predicted by a 50% drop in PTH intra-operatively. Vitamin D is a known inhibitor of PTH secretion and is associated with secondary HPT following adenoma resection. This study examined the impact of 25-hydroxyvitamin D (25OHD) deficiency on perioperative PTH kinetics and outcomes following parathyroidectomy.


METHODS
Patients undergoing adenoma resection for pHPT (n=93) had PTH levels recorded at six perioperative time points. Preoperative 25OHD levels were examined retrospectively. Patients were considered 25OHD deficient if the level was <25 ng/mL (n=47) and adequate if the level was >or=25 ng/mL (n=46).


RESULTS
Patients with 25OHD-deficiency had significantly higher preoperative calcium, alkaline phosphatase, and PTH levels. PTH levels were significantly higher in 25OHD-deficient patients at incision, at 1 week postop and 1-3 months postop. Average drop in PTH level five minutes post resection was 79+/-14% in the deficient group and 72+/-22% in the non-deficient group (P=.03). 25OHD levels inversely correlated with adenoma weight (P=.03) and postoperative PTH measurements (P=.008).


CONCLUSIONS
Sporadic pHPT patients with 25OHD deficiency have higher baseline and postoperative PTH levels compared to non-deficient patients but do not have altered intraoperative PTH kinetics. Vitamin D deficiency is associated with postoperative elevation of PTH.
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Brian R
BR
Untch
Michael E
ME
Barfield
Moahad
M
Dar
Darshana
D
Dixit
George S
GS
Leight
John A
JA
Olson
D000236:Adenoma / Q000097:blood / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications* / Q000601:surgery*; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery; D016105:Parathyroidectomy; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002118:Calcium