Tassone Francesco, Gianotti Laura, Baffoni Claudia, Visconti Gianluca, Pellegrino Micaela, Cassibba Sara, Croce Chiara Giulia, Magro Giampaolo, Cesario Flora, Attanasio Roberto, Borretta Giorgio
Division of Endocrinology, Diabetology and Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy.
Clin Endocrinol (Oxf). 2013 Dec;79(6):784-90. doi: 10.1111/cen.12210. Epub 2013 Apr 17.
Vitamin D deficiency (VDD) is common in patients with primary hyperparathyroidism (pHPT), and this could affect the clinical expression of the disease. However, few North American or North European studies have addressed this issue, showing vitamin D repletion in only about one-third of the patients.
Vitamin D status was evaluated both in an observational study in a series of 206 consecutive patients with pHPT at diagnosis and in a case-control analysis with 113 age- and sex-matched healthy blood donors. Vitamin D status was assessed by measuring plasma 25-hydroxy-vitamin D (25OHD) levels and was defined as VDD or severe VDD if 25OHD was <20 ng/ml (<50 nm) and <10 ng/ml (<25 nm), respectively.
No seasonal variability was observed in 25OHD levels. VDD was observed in 75 of 206 patients (36·4%). The VDD was severe in 24 of 75 patients (11·7%). There was no difference in prevalence of VDD between men and women nor between asymptomatic and 'bone and stone' symptomatic patients. 25OHD levels was negatively correlated with parathyroid hormone, ionized calcium, and bone turnover markers, and positively correlated with phosphate. 25OHD levels were also positively correlated with bone mineral density at all sites measured. In the case-control study, the overall prevalence of VDD and severe VDD was higher in patients with pHPT compared with controls (33·6% vs 10·6%, P < 0·0001, and 8·8% vs 1·8%, P = 0·0337, respectively).
Our study shows that VDD occurs in about one-third of patients with pHPT resident in a Southern European area, a lower figure than previously reported. Moreover, VDD is related to a more severe bone disease, and its prevalence is higher in patients with pHPT than in healthy matched subjects.
维生素D缺乏（VDD）在原发性甲状旁腺功能亢进症（pHPT）患者中很常见，这可能会影响该疾病的临床表现。然而，北美或北欧的研究很少涉及这个问题，仅约三分之一的患者显示维生素D得到补充。
在一项观察性研究中，对连续206例初诊pHPT患者进行了维生素D状态评估，并与113名年龄和性别匹配的健康献血者进行了病例对照分析。通过测量血浆25-羟基维生素D（25OHD）水平评估维生素D状态，如果25OHD分别<20 ng/ml（<50 nmol/L）和<10 ng/ml（<25 nmol/L），则定义为VDD或严重VDD。
未观察到25OHD水平有季节性变化。206例患者中有75例（36.4%）存在VDD。75例患者中有24例（11.7%）为严重VDD。男性和女性之间、无症状患者与“骨与石”有症状患者之间VDD的患病率无差异。25OHD水平与甲状旁腺激素、离子钙和骨转换标志物呈负相关，与磷酸盐呈正相关。25OHD水平与所有测量部位的骨密度也呈正相关。在病例对照研究中，pHPT患者中VDD和严重VDD的总体患病率高于对照组（分别为33.6%对10.6%，P<0.0001；8.8%对1.8%，P = 0.0337）。
我们的研究表明，居住在南欧地区的约三分之一pHPT患者存在VDD，这一数字低于先前报道。此外，VDD与更严重的骨病有关，且pHPT患者中其患病率高于健康匹配对象。
