L. F. Negrete Cervantes1, F. Cordera1, D. Caba1, E. Moreno1, E. Luque1, M. Muñoz1, E. Cruz1, D. Valdez1, J. Sanchez1, R. Arrangoiz1 1The American British Cowdray Medical Center,Sociedad Quirurgica At Departament Of Surgical Oncology And Head And Neck Tumors,Mexico City, , Mexico
Introduction:
Hyperparathyroidism (HPT) and vitamin D deficiency (VDD) are two associated conditions. In fact, VDD is frequently found in patients with HPT. There are several mechanisms that explain the relationship between HPT and VDD. It is well established that there is an inverse relationship between the levels of parathyroid hormone (PTH) and vitamin D (VD), however, VDD cannot be implicated as the primary cause of HPT (secondary HPT). The aim of our study is to determine if VDD causes HPT.
Methods:
We retrospectively reviewed a prospectively kept database of patients with HPT who were treated surgically from 2013 to 2017 by our surgical group. We obtained and analyzed the levels of VD, PTH, calcium.
Results:
We identified 50 patients (10 men / 40 women) with HPT with a median follow up of seven months (range 1-62). The median age was 56 years (range 29-87). The median preoperative PTH was 96.96 pg/ml (range 26.5-247). The median postoperative PTH at 24 hours and eight weeks after surgery was 33.7 pg/ml (range 1-116.2) and 51.74 pg/ml (range 0-137), respectively. The mean preoperative calcium was 10.15 mg/dL (range 8.8-11.9) and the mean postoperative calcium at 24 hours and eight weeks after surgery was 8.63 mg/dL (range 7.4-11) and 9.2 mg/dL (range 6.9-10.3), respectively. Thirty-five patients (58.3%) had preoperatively VDD before surgery and had subjective exacerbation of their HPT symptoms when the VD was replaced. The median preoperative VD level was 27.5 ng/dL (range 6-112) and at eight weeks after surgery was 25.51 ng/dL (range 17.2-50). This increase in VD levels occurred after the procedure without any VD supplementation. Pathology report showed, as expected, that the HPT was caused by adenomas in almost 89% of the cases and not by VDD.
Conclusion:
In our series, most patients had HPT secondary to adenomas, not 4 gland hyperplasia. VDD improved without VD supplementation after resection of the adenomas. These results may suggest that VDD does not cause HPT.