title: Primary hyperparathyroidism and metabolic risk factors, impact of parathyroidectomy and vitamin D supplementation, and results of a randomized double-blind study.
abstract: BACKGROUND
  Vitamin D insufficiency may increase the risk for cardio metabolic disturbances in patients with primary hyperparathyroidism (PHPT).
  
  
  OBJECTIVE
  To analyze the vitamin D status and indices of the metabolic syndrome in PHPT patients and the effect of vitamin D supplementation after parathyroid adenomectomy (PTX).
  
  
  METHODS
  Double-blinded, randomized clinical trial (ClinicalTrials.gov identifier: NCT00982722) performed at Karolinska University Hospital, Sweden, April 2008 to November 2011. One hundred and fifty consecutive patients with PHPT (119 women) were randomized after PTX, 75 to oral treatment with calcium carbonate 1000 mg daily and 75 to calcium carbonate 1000 mg and cholecalciferol 1600 IU daily over 12 months. Changes in metabolic profile and ambulatory blood pressure (BP) were analyzed. Main outcome measures were changes in metabolic factors, BP, and body composition.
  
  
  RESULTS
  The 25-hydroxyvitamin D (25-OH-D)-level was <50 nmol/l in 76% of the patients before PTX. After PTX, glucose, insulin, and IGF1 decreased, while the 25-OH-D and the IGF-binding protein 1 increased and remained unchanged at follow-up after study medication. One year of vitamin D supplementation resulted in lower parathyroid hormone (PTH) (40 (34-52) vs 49 (38-66) ng/l) and higher 25-OH-D (76 (65-93) vs 49 (40-62) nmol/l; P<0.05). Other laboratory parameters were stable compared with after PTX. Systolic BP decreased and total bone mineral content increased in both groups.
  
  
  CONCLUSIONS
  Except for the lowering of the PTH level, no additive effect of vitamin D supplementation was seen. However, PTX proved effective in reducing insulin resistance.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sophie
authors.initials: S
authors.lastname: Norenstedt
authors.forename: Ylva
authors.initials: Y
authors.lastname: Pernow
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
authors.forename: Maria
authors.initials: M
authors.lastname: Sääf
authors.forename: Ayla
authors.initials: A
authors.lastname: Ekip
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Jan
authors.initials: J
authors.lastname: Zedenius
authors.forename: Inga-Lena
authors.initials: IL
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D001823:Body Composition; D002119:Calcium Carbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood* / Q000172:deficiency; D016105:Parathyroidectomy / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D002762:Cholecalciferol; D002119:Calcium Carbonate
references.citation: Diabetologia. 2001 Mar;44(3):333-9
references.pmid: 11317665
references.citation: J Clin Endocrinol Metab. 2012 Jun;97(6):1953-61
references.pmid: 22442263
references.citation: Circulation. 2009 Jun 2;119(21):2765-71
references.pmid: 19451355
references.citation: Blood Press Monit. 2001 Dec;6(6):355-70
references.pmid: 12055415
references.citation: Diabetes Care. 2011 May;34(5):1133-8
references.pmid: 21430082
references.citation: J Clin Endocrinol Metab. 2009 Jul;94(7):2255-61
references.pmid: 19351725
references.citation: J Clin Endocrinol Metab. 2010 May;95(5):2172-9
references.pmid: 20228165
references.citation: J Clin Endocrinol Metab. 2003 May;88(5):2096-9
references.pmid: 12727960
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: N Engl J Med. 2001 Nov 1;345(18):1291-7
references.pmid: 11794147
references.citation: J Clin Endocrinol Metab. 2006 Nov;91(11):4260-3
references.pmid: 16895964
references.citation: Clin Exp Hypertens. 2010 May;32(3):154-8
references.pmid: 20504122
references.citation: Diabetologia. 2007 Feb;50(2):317-24
references.pmid: 17180664
references.citation: Best Pract Res Clin Endocrinol Metab. 2011 Aug;25(4):633-46
references.pmid: 21872804
references.citation: J Clin Endocrinol Metab. 2009 Feb;94(2):335-9
references.pmid: 19193908
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):1931-42
references.pmid: 21677037
references.citation: Clin Endocrinol (Oxf). 2005 Jul;63(1):94-102
references.pmid: 15963068
references.citation: J Endocrinol Invest. 2006 Jun;29(6):511-5
references.pmid: 16840828
references.citation: Am Heart J. 2011 Aug;162(2):331-339.e2
references.pmid: 21835295
references.citation: Blood Press. 1998 May;7(2):89-95
references.pmid: 9657535
references.citation: World J Surg. 2004 Jun;28(6):570-5
references.pmid: 15366747
references.citation: Surgery. 2001 Dec;130(6):986-90
references.pmid: 11742327
references.citation: J Hum Hypertens. 2005 Nov;19(11):901-6
references.pmid: 16034450
references.citation: J Intern Med. 2002 Jun;251(6):476-83
references.pmid: 12028502
references.citation: J Bone Miner Res. 2002 Nov;17 Suppl 2:N68-74
references.pmid: 12412780
references.citation: J Intern Med. 1995 Aug;238(2):121-30
references.pmid: 7543131
references.citation: Int J Endocrinol. 2012;2012:408295
references.pmid: 22719761
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):2112-8
references.pmid: 21593116
references.citation: Endocrine. 2012 Oct;42(2):231-3
references.pmid: 22531864
references.citation: J Hypertens. 2011 Apr;29(4):636-45
references.pmid: 21191311
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):2670-81
references.pmid: 22605432
references.citation: Nephron. 1976;16(1):31-41
references.pmid: 1244564
references.citation: Surgery. 1999 Dec;126(6):1049-55
references.pmid: 10598187
references.citation: Cardiovasc Res. 2000 Sep;47(4):813-8
references.pmid: 10974230
references.citation: Surgery. 1998 Dec;124(6):980-5; discussion 985-6
references.pmid: 9854572
references.citation: Acta Endocrinol (Copenh). 1984 Dec;107(4):563-70
references.pmid: 6083690
references.citation: Am J Cardiol. 2010 Oct 1;106(7):963-8
references.pmid: 20854958
references.citation: Surgery. 2003 Dec;134(6):1013-9; discussion 1019
references.pmid: 14668735
references.citation: Int J Cardiol. 2010 Jun 25;142(1):15-21
references.pmid: 19117619
references.citation: J Clin Endocrinol Metab. 2012 Nov;97(11):3989-95
references.pmid: 22933544
references.citation: J Endocrinol Invest. 1988 Sep;11(8):599-602
references.pmid: 2468706
references.citation: Diabetes Metab. 2009 Jun;35(3):198-205
references.pmid: 19297224
references.citation: Eur J Endocrinol. 2010 Sep;163(3):461-7
references.pmid: 20562163
references.citation: Hypertension. 2003 Oct;42(4):453-6
references.pmid: 12975387