Abstract
Background
Deficiency of 25-hydroxyvitamin D (25OHD) is a stimulus for the secretion of parathyroid hormone (PTH). During surgery for primary hyperparathyroidism, 25OHD deficiency may artificially elevate PTH, decreasing the sensitivity of intraoperative PTH (ioPTH) measurements.
Materials and Methods
Of 351 patients with known 25OHD status who underwent curative surgical treatment of primary hyperparathyroidism, 198 (56%) patients were 25OHD deficient (<25 ng/mL). A curative decrease in ioPTH was defined as a greater than 50% PTH decrease 5, 10, or 15 min after resection.
Results
There was no statistical difference between 25OHD deficient and sufficient patients in PTH, phosphorous, and alkaline phosphatase preoperatively. There was a positive correlation between PTH and calcium, alkaline phosphatase, and gland weight, while there was an inverse correlation between preoperative PTH and 25OHD. The average ioPTH decrease was not significantly different after 5, 10, or 15 min, and 25OHD status did not affect when ioPTH indicated surgical cure.
Conclusions
Lower 25OHD levels are correlated with higher PTH and alkaline phosphatase levels in patients with primary hyperparathyroidism. 25OHD status did not affect the average percent ioPTH decrease or the rate of cure. 25OHD deficiency does not affect ioPTH dynamics.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Beyer TD, Chen EL, Nilubol N, Prinz RA, Solorzano CC. Short-term outcomes of parathyroidectomy in patients with or without 25-hydroxy vitamin D insufficiency. J Surg Res. 2007;143:145–50.
Chen H, Mack E, Starling JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg. 2005;242:375–80; discussion 380–3.
Egan KR, Adler JT, Olson JE, Chen H. Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res. 2007;140:194–8.
Adler JT, Sippel RS, Chen H. The influence of surgical approach on quality of life after parathyroid surgery. Ann Surg Oncol. 2008;15:1559–65.
Adler JT, Sippel RS, Schaefer S, Chen H. Preserving function and quality of life after thyroid and parathyroid surgery. Lancet Oncol. 2008;9:1069–75.
Mihai R, Sadler GP. Pasieka’s parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg. 2008;32:807–14.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
Robinson JA, Susulic V, Liu YB, Taylor C, Hardenburg J, Gironda V, et al. Identification of a PTH regulated gene selectively induced in vivo during PTH-mediated bone formation. J Cell Biochem. 2006;98:1203–20.
Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol. 2005;288:F253–64.
Silver J, Levi R. Regulation of PTH synthesis and secretion relevant to the management of secondary hyperparathyroidism in chronic kidney disease. Kidney Int Suppl. 2005;S8–12.
Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, et al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab. 2000;85:1054–8.
Silverberg SJ. Vitamin D deficiency and primary hyperparathyroidism. J Bone Miner Res. 2007;22(Suppl 2):V100–4.
Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery. 2005;138:1130–5; discussion 1135–6.
Redman C, Bodenner D, Stack B, Jr. Role of vitamin D deficiency in continued hyperparathyroidism following parathyroidectomy. Head Neck. 2009;31:1164–7.
Beyer TD, Solorzano CC, Prinz RA, Babu A, Nilubol N, Patel S. Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism. Surgery. 2007;141:777–83.
Carty SE, Roberts MM, Virji MA, Haywood L, Yim JH. Elevated serum parathormone level after “concise parathyroidectomy” for primary sporadic hyperparathyroidism. Surgery. 2002;132:1086–92; discussion 1092–3.
Chen H. Radioguided parathyroid surgery. Adv Surg. 2004;38:377–92.
Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery. 1999;126:1016–21; discussion 1021–2.
Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–7; discussion 587–90.
Untch BR, Barfield ME, Dar M, Dixit D, Leight GS, Olson JA. Impact of 25-hydroxyvitamin D deficiency on perioperative parathyroid hormone kinetics and results in patients with primary hyperparathyroidism. Surgery. 2007;142:1022–6; discussion 1027–9.
Weaver S, Doherty DB, Jimenez C, Perrier ND. Peer-reviewed, evidence-based analysis of vitamin D and primary hyperparathyroidism. World J Surg. 2009;33:2292–302.
Grubbs EG, Rafeeq S, Jimenez C, Feng L, Lee JE, Evans DB, et al. Preoperative vitamin D replacement therapy in primary hyperparathyroidism: safe and beneficial? Surgery. 2008;144:852–8; discussion 858–9.
Tucci JR. Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D. Eur J Endocrinol. 2009;161:189–93.
Acknowledgment
Joel T. Adler is a Howard Hughes Medical Institute Research Training Fellow and is supported by the University of Wisconsin Institute for Clinical and Translational Research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Adler, J.T., Sippel, R.S. & Chen, H. 25-Hydroxyvitamin D Status Does Not Affect Intraoperative Parathyroid Hormone Dynamics in Patients with Primary Hyperparathyroidism. Ann Surg Oncol 17, 2958–2962 (2010). https://doi.org/10.1245/s10434-010-1125-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-010-1125-x