Bussey Aaron D, Bruder Jan M
Division of Endocrinology, University of Texas Health Science Center, San Antonio, TX 78284-7877, USA.
Endocr Pract. 2005 Jan-Feb;11(1):37-42. doi: 10.4158/EP.11.1.37.
To determine the prevalence of vitamin D deficiency in patients with primary hyperparathyroidism (PHPT) and evaluate the relationship between urinary calcium excretion and serum 25-hydroxyvitamin D (25-OH-D) levels in patients with PHPT.
We present a case report and a review of the medical records of patients with PHPT. Of 75 patients with PHPT substantiated by hypercalcemia and increased levels of intact parathyroid hormone (iPTH), 35 were identified with laboratory evaluation of vitamin D levels and 24-hour urinary calcium excretion. These study subjects were stratified as 25-OH-D deficient, insufficient, or replete (on the basis of serum values of <15, 15 to 25, or >25 ng/mL, respectively). Total 24-hour urinary calcium excretion and the fractional excretion of calcium (FECa) were analyzed as a function of 25-OH-D status.
Of the 35 study subjects, 14 (40%) and 13 (37%) had 25-OH-D deficiency or insufficiency, respectively. Those patients with a 25-OH-D level <15 ng/mL had higher serum iPTH concentrations as well as lower urinary calcium excretion and FECa. No significant correlations were found, however, between 25-OH-D status and iPTH concentrations (r = -0.21; P = 0.23), total 24-hour urinary calcium excretion (r = 0.07; P = 0.7), or FECa (r = 0.04; P = 0.8).
Vitamin D deficiency (25-OH-D levels <15 ng/mL) was common in our population of patients with PHPT. Urinary calcium excretion was not significantly altered by 25-OH-D deficiency in patients with newly recognized PHPT. Measurements of total urinary calcium excretion and FECa can be reliably used to rule out familial benign hypocalciuric hypercalcemia in the initial evaluation of PHPT, regardless of 25-OH-D status. Determining 25-OH-D concentrations best assesses the vitamin D status.
确定原发性甲状旁腺功能亢进症（PHPT）患者维生素D缺乏的患病率，并评估PHPT患者尿钙排泄与血清25-羟基维生素D（25-OH-D）水平之间的关系。
我们报告了1例病例，并回顾了PHPT患者的病历。在75例因高钙血症和完整甲状旁腺激素（iPTH）水平升高而确诊为PHPT的患者中，35例通过维生素D水平和24小时尿钙排泄的实验室评估进行了鉴定。这些研究对象根据血清值分别分为25-OH-D缺乏、不足或充足（分别为<15、15至25或>25 ng/mL）。分析24小时总尿钙排泄量和钙分数排泄率（FECa）与25-OH-D状态的关系。
在35例研究对象中，分别有14例（40%）和13例（37%）存在25-OH-D缺乏或不足。25-OH-D水平<15 ng/mL的患者血清iPTH浓度较高，而尿钙排泄量和FECa较低。然而，未发现25-OH-D状态与iPTH浓度（r = -0.21；P = 0.23）、24小时总尿钙排泄量（r = 0.07；P = 0.7）或FECa（r = 0.04；P = 0.8）之间存在显著相关性。
在我们的PHPT患者群体中，维生素D缺乏（25-OH-D水平<15 ng/mL）很常见。新诊断的PHPT患者中，维生素D缺乏并未显著改变尿钙排泄。在PHPT的初始评估中，无论25-OH-D状态如何，总尿钙排泄量和FECa的测量均可可靠地用于排除家族性良性低钙血症性高钙血症。测定25-OH-D浓度最能评估维生素D状态。
