Rao D Sudhaker, Agarwal Gaurav, Talpos Gary B, Phillips Evelyn R, Bandeira Franciso, Mishra Saroj K, Mithal Ambrish
Department of Medicine, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
J Bone Miner Res. 2002 Nov;17 Suppl 2:N75-80.
Since the classic description by Fuller Albright in the 1940s, primary hyperparathyroidism has evolved from a disease with classic signs and symptoms to a disease in search of symptoms! Since that time, two major events have occurred. First, in the United States, United Kingdom, and in most European countries, there has been a steady rise in the apparent incidence of the disease. Second, there has been a dramatic shift in the pattern of presentation. A majority of patients with primary hyperparathyroidism in countries with multichannel screening panels are asymptomatic. Skeletal and renal complications are uncommon, and osteitis fibrosa is rare. In contrast, the clinical presentation of primary hyperparathyroidism has changed very little in other regions such as the East, the Middle East, and some parts of the southern hemisphere over the same period of observation. Accordingly, we assessed the influence of vitamin D and calcium nutrition on the disease expression and parathyroid tumor growth in patients with primary hyperparathyroidism from different parts of the world. Between 1945 and 1950, both the prevalence of osteitis fibrosa and parathyroid tumor weight declined dramatically in the United States, coinciding with fortification of milk with vitamin D. In contrast, osteitis fibrosa and parathyroid tumor weight changed very little in parts of the world where vitamin D depletion is endemic. Furthermore, for a comparable degree of vitamin D depletion, Asian Indians have significantly larger tumors compared with Americans (3.95 +/- 2.23 vs. 0.66 +/- 2.84 g; p < 0.001). Within the United States, blacks have larger tumors compared with whites (0.78 +/- 2.87 vs. 0.58 +/- 2.78 g; p < 0.01). However, the slopes of regression between serum 25-hydroxyvitamin D, the best index of vitamin D nutrition, and parathyroid tumor weight, the best available index of parathyroid growth, were not significantly different between Asian Indians, whites, and blacks. We conclude that vitamin D and calcium nutrition of the population affect both the clinical expression and parathyroid tumor growth in patients with primary hyperparathyroidism. It will be of interest to see if the pattern of presentation of primary hyperparathyroidism changes when better nutritional policies are implemented in developing countries.
自20世纪40年代富勒·奥尔布赖特作出经典描述以来，原发性甲状旁腺功能亢进已从一种具有典型体征和症状的疾病演变成一种寻找症状的疾病！从那时起，发生了两件大事。第一，在美国、英国和大多数欧洲国家，该病的表观发病率一直在稳步上升。第二，其临床表现模式发生了巨大转变。在拥有多通道筛查项目的国家，大多数原发性甲状旁腺功能亢进患者没有症状。骨骼和肾脏并发症并不常见，纤维性骨炎也很罕见。相比之下，在同一观察期内，原发性甲状旁腺功能亢进在其他地区（如东方、中东和南半球的一些地区）的临床表现变化很小。因此，我们评估了维生素D和钙营养对来自世界不同地区的原发性甲状旁腺功能亢进患者疾病表现和甲状旁腺肿瘤生长的影响。1945年至1950年间，美国纤维性骨炎的患病率和甲状旁腺肿瘤重量均大幅下降，这与牛奶强化维生素D同时发生。相比之下，在维生素D缺乏流行的世界部分地区，纤维性骨炎和甲状旁腺肿瘤重量变化很小。此外，对于维生素D缺乏程度相当的情况，亚洲印度人的肿瘤明显大于美国人（3.95±2.23对0.66±2.84克；p<0.001）。在美国国内，黑人的肿瘤比白人的大（0.78±2.87对0.58±2.78克；p<0.01）。然而，血清25-羟基维生素D（维生素D营养的最佳指标）与甲状旁腺肿瘤重量（甲状旁腺生长的最佳可用指标）之间的回归斜率在亚洲印度人、白人和黑人之间没有显著差异。我们得出结论，人群的维生素D和钙营养会影响原发性甲状旁腺功能亢进患者的临床表型和甲状旁腺肿瘤生长。看看在发展中国家实施更好的营养政策时，原发性甲状旁腺功能亢进的表现模式是否会改变将会很有意思。
