Annals of Surgical Oncology

, Volume 17, Issue 11, pp 2958–2962 | Cite as

25-Hydroxyvitamin D Status Does Not Affect Intraoperative Parathyroid Hormone Dynamics in Patients with Primary Hyperparathyroidism

Endocrine Tumors

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.

Keywords

Primary Hyperparathyroidism Surgical Cure Gland Weight Single Adenoma Invasive Parathyroidectomy 

Notes

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.

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Silverberg SJ. Vitamin D deficiency and primary hyperparathyroidism. J Bone Miner Res. 2007;22(Suppl 2):V100–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery. 2005;138:1130–5; discussion 1135–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Redman C, Bodenner D, Stack B, Jr. Role of vitamin D deficiency in continued hyperparathyroidism following parathyroidectomy. Head Neck. 2009;31:1164–7.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    Chen H. Radioguided parathyroid surgery. Adv Surg. 2004;38:377–92.PubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Tucci JR. Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D. Eur J Endocrinol. 2009;161:189–93.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Joel T. Adler
    • 1
  • Rebecca S. Sippel
    • 1
  • Herbert Chen
    • 1
  1. 1.Section of Endocrine Surgery, Department of SurgeryUniversity of WisconsinMadisonUSA

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