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Primary hyperparathyroidism surgery associated with 8 X increased risk of bone fracture if low vitamin D – May 2018

Impact of vitamin D status in clinical, biochemical, radiological and pathological parameters in primary hyperparathyroidism

Endocrine Abstracts (2018) 56 P245 | DOI: 10.1530/endoabs.56.P245
20th European Congress of Endocrinology , Barcelona, Spain, 19 - 22 May 2018
Paloma Iglesias1,2, Sonsoles Gutierrez2, Raquel Barba2, Miguel Angel Delgado1, Manuel Duran2, Clotilde Vazquez2, Guadalupe Guijarro1 & Isabel Pavon1
1Hospital Universitario De Getafe, Madrid, Spain; 2Hospital Rey Juan Carlos, Madrid, Spain.

To determine the effects of 25-hydroxyvitamin D (25-OHD) status on parathyroid adenoma weight, clinical, radiological and biochemical phenotype in patients with primary hyperparathyroidism (HPTP) were studied.

Methods: Eighty-two patients with pHPT who underwent surgical treatment and in whom the presence of parathyroid adenoma were confirmed histopathologically were studied retrospectively. Patients were divided into 2 groups: group A patients with 25-OHD concentrations < 20 ng/ml (n=49) and group B patients with 25-OHD concentrations ≥ 20 ng/ml (n=33). Serum parathyroid hormone (PTH), albumin-corrected serum calcium, phosphate, alkaline phosphatase and urinary calcium excretion were determined. The results of preoperative imaging modalities (ultrasound, planar scintigraphy and SPECT/CT) and parathyroid adenoma weight were recorded.

Results: 74% of patients presented vitamin D insufficiency (< 20 ng/dl). No statistically significant differences were observed with respect to serum calcium, phosphorus, PTH, alkaline phosphatase concentrations, urinary calcium excretion and parathyroid adenoma weight between groups. The history of bone fracture was more frequent in group A (9.7% vs 1.2% P=0.03). Likewise, group A presented lower values of bone mineral density at femoral site, although it did not reach statistical significance (0.67 vs 0.73, P=0.07). Significant correlations were observed between 25 OHD and femoral mineral density (r=0.331, P=0.01), and serum PTH (r=−0.233, P=0.03). Parathyroid adenoma weight correlated with serum calcium (r=0.404, P<0.001), serum phosphate (r=−0.243, P=0.03), and PTH (r=0.523, P<0.001). No biochemical/pathological features were suggested to influence in the localization studies.

Conclusions: Vitamin D deficiency is a common disorder in patients with HPTP. It seems to lead to more severe bone disease. Our results suggest that there is not an effect of vitamin D deficiency on parathyroid tumor growth.

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