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

Abstract Background: The recent development of nonradioactive automated assays for serum parathyroid hormone (PTH) and 25-hydroxyvitamin D (25OHD) has made measurement of these two hormones possible in many laboratories. In this study, we compared two new assays for PTH and 25OHD adapted on an automated analyzer, the LIAISON®, with two manual immunoassays used worldwide. Methods: We studied 228 osteoporotic patients, 927 healthy individuals, 38 patients with primary hyperparathyroidism, and 167 hemodialyzed patients. Serum PTH was measured with the Allegro® and the LIAISON assays, and 25OHD was measured with DiaSorin RIA and the LIAISON assay. Regression analysis was used to calculate decision thresholds for the LIAISON assays that were equivalent to those of the Allegro PTH and DiaSorin 25OHD assays. Results: The 25OHD concentrations obtained with the LIAISON assay and the RIA in osteoporotic patients were well correlated (r = 0.83; P <0.001). Regression and Bland–Altman analyses suggested that the LIAISON 25OHD assay reads lower than the DiaSorin RIA at low concentrations but higher at high concentrations. However, the cutoff (50 nmol/L) used in our laboratories to define vitamin D insufficiency with the DiaSorin RIA is applicable to the LIAISON 25OHD assay. In 927 healthy individuals, the 3rd–97th percentile intervals were 3–80 ng/L and 13–151 nmol/L for the LIAISON PTH and 25OHD concentrations, respectively. However, 506 individuals (54.6%) were vitamin D-insufficient; we therefore considered only the 421 individuals with a LIAISON 25OHD >50 nmol/L as eligible for the reference population for the LIAISON PTH assay. In this group, the 3rd–97th percentile interval for LIAISON PTH was 3–51 ng/L. Considering upper reference limits of 46 and 51 ng/L for the Allegro and LIAISON assays, respectively, the frequency of above-normal PTH concentrations in patients with primary hyperparathyroidism was similar in both assays. Regression analysis between serum PTH measured by the Allegro and LIAISON assays in 167 hemodialyzed patients and the corresponding Bland–Altman analysis of these data suggest that the LIAISON PTH assay tends to read higher than the Allegro assay at low concentrations but lower at high concentrations (>300 ng/L). Conclusions: Because clinical decision limits for both PTH and 25OHD should be assay specific, we propose equivalences between these assays and two manual assays used worldwide. These assay-specific decision limits should help potential users of the LIAISON PTH and 25OHD assays.

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Impact of 25 hydroxyvitamin D deficiency in perioperative parathyroid hormone kinetics and results in patients with primary hyperparathyroidism

Surgery ◽

10.1016/j.surg.2007.09.025 ◽

2007 ◽

Vol 142 (6) ◽

pp. 1027-1029 ◽

Cited By ~ 3

Author(s):

Nancy D. Perrier

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Parathyroid Hormone Kinetics

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Analyses of Predictive Factors Associated with Hypocalcemia and Elevated iPTH with Normocalcemia after Ultrasound-guided Radiofrequency Ablation for Primary Hyperparathyroidism

10.21203/rs.3.rs-422854/v1 ◽

2021 ◽

Author(s):

Hui-Hui Chai ◽

Yu Zhao ◽

Rui-Zhong Ye ◽

Zeng Zeng ◽

Zheng-Xian Zhang ◽

...

Keyword(s):

Parathyroid Hormone ◽

Radiofrequency Ablation ◽

Primary Hyperparathyroidism ◽

Predictive Factors ◽

Elevated Serum ◽

Intact Parathyroid Hormone ◽

Ultrasound Guided ◽

Serum Ipth ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

Abstract Purpose To assess the feasibility of ultrasound-guided (US-guided) radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT) and determine predictive factors for hypocalcemia and elevated serum intact parathyroid hormone(ePTH) with normocalcemia after ablation. Materials and Methods Between January 2015 and January 2021, data from 44 patients with PHPT who were treated with US-guided RFA were retrospectively evaluated. Serum intact parathyroid hormone(iPTH), total calcium (Ca), phosphorus, alkaline phosphatase (ALP), and 25-hydroxyvitamin D3 (25(OH)D3) levels and the volume of the abnormal enlarged parathyroid glands were recorded before RFA. Changes in iPTH and Ca levels at 1 and 3 days, and, 1, 3, and 6 months after ablation were recorded. Results Overall, thirteen patients developed hypocalcemia 1–3 days after RFA. ePTH with normocalcemia developed in 17 patients 1 month after RFA. Thirty-two patients were followed up for more than 6 months, and 27 of these patients had sustained normalized values for both serum iPTH and Ca levels more than 6 months after RFA. There were significantly more patients who developed hypocalcaemia, when the baseline ALP was greater than 261.5 U/L (sensitivity 61.5%, specificity 100.0%). The risk of ePTH decreased by 21.7% for every 1 ng/mL increase in 25 (OH) D3. The risk of ePTH was increased when a patient's serum iPTH was higher than 172.4 pg/mL (sensitivity 88.2%, specificity 76.2%). Conclusions US-guided RFA is feasible for clinical management of PHPT patients. Hypocalcaemia following RFA was associated with higher pre-RFA serum ALP levels. Elevated iPTH levels with normocalcemia at 1 month after RFA were associated with pre-RFA vitamin D deficiency and higher baseline iPTH levels. Patients with higher serum ALP and iPTH and lower 25 (OH) D3 levels before RFA need to be managed carefully and monitored closely after RFA of PHPT.

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Impact of 25-Hydroxyvitamin D Deficiency on Perioperative Parathyroid Hormone Kinetics and Results in Patients with Primary Hyperparathyroidism

Surgery ◽

10.1016/j.surg.2007.09.026 ◽

2007 ◽

Vol 142 (6) ◽

pp. 1022-1026 ◽

Cited By ~ 44

Author(s):

Brian R. Untch ◽

Michael E. Barfield ◽

Moahad Dar ◽

Darshana Dixit ◽

George S. Leight ◽

...

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Parathyroid Hormone Kinetics

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LOW FREE (BUT NOT TOTAL) 25-HYDROXYVITAMIN D LEVELS IN SUBJECTS WITH NORMOCALCEMIC HYPERPARATHYROIDISM

Endocrine Practice ◽

10.4158/ep-2019-0325 ◽

2020 ◽

Vol 26 (2) ◽

pp. 174-178 ◽

Cited By ~ 4

Author(s):

Xiangbing Wang ◽

Lingqiong Meng ◽

Chi Su ◽

Sue A. Shapses

Keyword(s):

Body Mass Index ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Body Mass ◽

Hydroxyvitamin D ◽

Control Subjects ◽

Healthy Control ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Normocalcemic Hyperparathyroidism

Objective: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevated parathyroid hormone (PTH) levels with persistently normal calcium levels. The diagnosis of NPHPT assumes the absence of secondary causes of elevated PTH levels. The objective of the current study was to examine levels of free 25-hydroxyvitamin D (25[OH]D) in NPHPT subjects and healthy controls. Methods: Ten NPHPT subjects and 20 controls who were age, sex, race, and body mass index (BMI) matched were examined. The diagnosis of NPHPT was made if subjects had ( 1) a serum calcium level of 8.6 to 10.4 mg/dL, total 25(OH)D 30 to 40 ng/mL, and intact PTH (iPTH) ≥66 pg/mL; and ( 2) normal renal and liver function. Serum total 25(OH)D levels were measured by radioimmunoassay, and free 25(OH)D levels were determined using an enzyme-linked immunoassay. Results: Mean age of NPHPT subjects was 59.9 ± 5.4 years, and mean BMI was 28.4 ± 2.3 kg/m2, which was not significantly different from the mean age and BMI of the control subjects. Mean total 25(OH)D level was 31.9 ± 1.7 ng/mL in NPHPT subjects and did not differ from that of the controls (32.7 ± 3.3 ng/mL; P = .52). However, mean free 25(OH)D was 5.0 ± 0.9 pg/mL in NPHPT subjects, which was 20% lower compared to the mean of the controls (6.2 ± 1.3 pg/mL; P = .013). Serum iPTH levels were inversely correlated with levels of measured free 25(OH)D ( r = −0.42; P<.05) but did not correlate with levels of total 25(OH)D ( r = −0.14; P>.10). Conclusion: Measured free 25(OH)D levels are lower in NPHPT subjects than in healthy control subjects. We suggest that some NPHPT subjects may actually have secondary hyperparathyroidism based on their free 25(OH) D levels. Abbreviations: 25(OH)D = 25-hydroxyvitamin D; BMI = body mass index; CV = coefficient of variation; DBP = vitamin D–binding protein; iPTH = intact parathyroid hormone; NPHPT = normocalcemic primary hyperparathyroidism

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Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/eje-08-0440 ◽

2008 ◽

Vol 159 (6) ◽

pp. 719-727 ◽

Cited By ~ 30

Author(s):

Signe Engkjær Christensen ◽

Peter H Nissen ◽

Peter Vestergaard ◽

Lene Heickendorff ◽

Lars Rejnmark ◽

...

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Plasma Levels ◽

Familial Hypocalciuric Hypercalcemia ◽

Vitamin D Metabolism ◽

Hydroxyvitamin D ◽

Dihydroxyvitamin D ◽

1,25 Dihydroxyvitamin D ◽

25 Hydroxyvitamin D

IntroductionFamilial hypocalciuric hypercalcemia (FHH) is a lifelong, benign, inherited condition caused by inactivating mutations in the calcium-sensing receptor (CASR) gene. Both FHH and primary hyperparathyroidism (PHPT) are characterized by elevated P-calcium, normal or elevated plasma-parathyroid hormone (P-PTH), and typically normal renal function. In PHPT, vitamin D metabolism is typically characterized by low plasma levels of 25-hydroxyvitamin D (25OHD), and high plasma levels of 1,25-dihydroxyvitamin D (1,25(OH)2D). In FHH, the vitamin D metabolism is not very well known.ObjectiveTo compare and evaluate plasma 25OHD, 1,25(OH)2D, and PTH in FHH and PHPT.DesignCross-sectional study.MaterialsAbout 66 FHH patients with mutations in the CASR gene, 147 patients with surgically verified PHPT, and 46 controls matched to FHH patients according to age (±5 years), sex, and season. All patients had a P-creatinine <140 μmol/l.MethodsWe measured P-calcium, P-Ca2+, P-albumin, P-creatinine, P-phosphate, P-magnesium, and P-PTH by standard laboratory methods. P-25OHD and P-1,25(OH)2D were measured by RIA or enzyme immunoassay. In FHH, all protein-coding exons in the CASR gene were sequenced and aligned to GenBank reference sequence .ResultsPHPT patients had higher body mass index (2p<0.01), together with higher P-PTH (2p<0.01) and P-1,25(OH)2D (2p<0.01) compared with FHH patients. The groups had similar levels of P-Ca2+ and of P-25OHD. The phenotypic expression of the CASR mutations (as determined by the degree of hypercalcemia) did not influence the levels of P-1,25(OH)2D.ConclusionEven though P-calcium and P-25OHD were comparable, P-1,25(OH)2D and P-PTH differed between FHH and PHPT.

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