Kantorovich V, Gacad M A, Seeger L L, Adams J S
Burns and Allen Research Institute and Division of Endocrinology, Diabetes, and Metabolism, Cedars-Sinai Medical Center, University of California School of Medicine, Los Angeles 90048, USA.
J Clin Endocrinol Metab. 2000 Oct;85(10):3541-3. doi: 10.1210/jcem.85.10.6909.
Two hundred and twenty-nine consecutive subjects, 202 women and 27 men, referred for evaluation of osteoporosis or low bone mineral density (BMD) had serum measurements of immunoreactive PTH (iPTH) and 25-hydroxyvitamin D (25OHD) performed. Fifteen individuals (mean age +/- SE, 75+/-2.4 yr) had depressed serum 25OHD (<15 pg/mL) and concomitantly elevated (>65 pg/mL) iPTH levels. After successful treatment of vitamin D insufficiency in all subjects, iPTH remained inappropriately high or frankly elevated in 5, describing a 2.2% prevalence rate of coexistent primary hyperparathyroidism and vitamin D insufficiency in our population. Despite persistent primary hyperparathyroidism, normalization of serum 25OHD levels in these 5 subjects increased their BMD at an annual rate of 6.3% and 8.2% in spine and hip, respectively. Our results suggest that coexistent vitamin D insufficiency can obscure the diagnosis of primary hyperparathyroidism and, when treated effectively, can result in substantial short-terms gains in BMD despite persistence of the inappropriate production of PTH.
连续229名因骨质疏松或低骨密度（BMD）前来评估的受试者（202名女性和27名男性）进行了血清免疫反应性甲状旁腺激素（iPTH）和25-羟基维生素D（25OHD）检测。15名个体（平均年龄±标准误，75±2.4岁）血清25OHD水平降低（<15 pg/mL），同时iPTH水平升高（>65 pg/mL）。在所有受试者维生素D缺乏成功治疗后，5名受试者的iPTH仍异常升高或显著升高，表明在我们的研究人群中，原发性甲状旁腺功能亢进和维生素D缺乏并存的患病率为2.2%。尽管这5名受试者原发性甲状旁腺功能亢进持续存在，但血清25OHD水平正常化后，其脊柱和髋部的骨密度分别以每年6.3%和8.2%的速度增加。我们的结果表明，维生素D缺乏并存可能会掩盖原发性甲状旁腺功能亢进的诊断，并且在有效治疗后，尽管甲状旁腺激素分泌仍不适当，但短期内骨密度会有显著增加。
