Differential Diagnosis of Primary and Secondary Hyperparathyroidism Caused by Vitamin D Deficiency
Main Article Content
Abstract
Causes of secondary increase of parathyroid hormone, especially vitamin D deficiency, can significantly interfere with the diagnosis of hyperparathyroidism. The most difficult situation occurs when moderate increase in parathyroid hormone coincides with slightly elevated or normal levels of calcium in the blood serum. Given the predominantly surgical way of treating patients with primary hyperparathyroidism, it is important to distinguish vitamin D deficiency and indeed primary hyperparathyroidism.
Objective: to develop a method for the differentiation of primary and secondary hyperparathyroidism associated with vitamin D deficiency.
Materials and methods. We provide reliable, standardized protocol for short treatment with ergocalciferol (3000 IU a day for 45–50 days) to remove the effects of vitamin D deficiency on laboratory criteria of primary hyperparathyroidism. Reduction of more than 30 % and normalization of serum parathyroid hormone without serum calcium increase exclude primary hyperparathyroidism and the need for surgery.
Results. We have studied a clinical group of 72 selected patients who meet the criteria of moderately elevated parathyroid hormone, normal or slightly increased levels of calcium, with vitamin D deficiency, absence of chronic kidney diseases or malabsorption. After 45–50 days of vitamin D intake, the normalization of parathyroid hormone without hypercalcaemia was observed in 61 patients (85 %). They were excluded from the clinical group of primary hyperparathyroidism. Hereafter, we did not observe cases of primary hyperparathyroidism progression in this group. The rest of the patients (10 of 72) were successfully operated for primary hyperparathyroidism, except one patient which refused surgery and is still under observation.
Conclusions. Short ergocalciferol treatment can be a valuable and reliable clinical method to differentiate isolated vitamin D deficiency and asymptomatic primary hyperparathyroidism combined with a lack of vitamin D.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
References
Silverberg S.J. Vitamin D Deficiency and Primary Hyperparathyroidism // J. Bone and Mineral Research. — 2007. — Vol. 22, Suppl. 2. — P. 100-104.
Glendenning P., Gutteridge D.H., Retallack R.W. et al. High prevalence of normal total calcium and intact PTH in 60 patients with proven primary hyperparathyroidism: a challenge to current diagnostic criteria // Austr. N.Z.J. Med. — 1998. — 28. — P. 173-178.
Heaney R.P. Vitamin D Endocrine Physiology // J. Bone and Mineral Research. — 2007. — Vol. 22, Suppl. 2. — P. 25-27.
Поворознюк В.В., Балацька H.І., Муц В.Я., Вдовіна О.А. Дефіцит та недостатність вітаміну D у жителів України // Боль. Суставы. Позвоночник. — 2011. — № 4. — С. 5-13.
Jones G. Extrarenal vitamin D activation and interactions between vitamin D2, vitamin D3, and vitamin D analogs // Ann. Rev. Nutr. — 2013. — 33. — P. 23-44.
Rolighed L., Rejnmark L., Sikjaer T. et al. Vitamin D Treatment in Primary Hyperparathyroidism: a Randomized Placebo Controlled Trial // J. Clin. Endocrinol. Metab. — 2014. — 13. — P. 1072-1080.
Rathi M.S., Gonzalez S., Wright D. et al. Management of hypovitaminosis D in patients with primary hyperparathyroidism // Journal of Endocrinological Investigation. — 2014. — 37. — P. 467-471.
Shah V.N., Shah C.S., Bhadada S.K., Rao D.S. Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: a meta-analysis and review of literature // Clin. Endocrinol. — 2014. — Vol. 80. — P. 797-803.
Silverberg S.J., Bilezikian J.P. Evaluation and management of primary hyperparathyroidism // J. Clin. Endocrinol. Metab. — 1996. — 81. — P. 2036-2040.
Harvey A., Hu M.J., Gupta M. et al. A New, Vitamin D-Based, Multidimensional Nomogram for the Diagnosis of Primary Hyperparathyroidism // Endocr. Pract. — 2012. — 18. — P. 124-131.