<p>Evaluation of Serum Level of FGF23 and 1,25(OH)₂D₃ in Primary Hyperparathyroidism Patients Before and After Parathyroidectomy</p>

Abstract

Purpose: Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) play critical roles in phosphate homeostasis. To the best of our knowledge, there are limited data on the impact of FGF23 and PTH on serum calcium, 1,25(OH) 2 D 3 , and phosphate in patients with primary hyperparathyroidism (PHPT). We examined these parameters and their correlations in PHPT patients before and after parathyroidectomy (PTX). Patients and Methods: In this prospective cohort study, 29 PHPT patients who met the inclusion criteria were selected. The patient's blood samples were taken three times: before the operation, 24 h after the operation, and 1 week after the operation. The concentrations of serum calcium, FGF23, 1,25(OH) 2 D 3 , phosphate, PTH, and alkaline phosphatase were measured in a referral laboratory at each of the three steps. Moreover, 25(OH)D was primarily measured just before the surgery. Results: Of 29 patients included in this study with a mean age of 52.37±12.3 years, majority were females (75.8%). Serum FGF23 and 1,25(OH) 2 D 3 levels were high before PTX and decreased after the operation; however, the difference was not statistically significant. FGF23 levels were significantly correlated with 1,25(OH) 2 D 3 at each of the three steps (r=0.964, P <0.01; r=0.985, P <0.0; and r=0.976, P <0.05). The variations in calcium, phosphate, creatinine, and PTH were preoperatively and postoperatively significant. Conclusion: Although 1,25(OH) 2 D 3 and FGF23 levels were preoperatively higher in PHPT, their variations were not meaningful. There was a statistically direct significant relationship between 1,25(OH) 2 D 3 and FGF23 preoperatively and postoperatively; however, the correlations between FGF23 and calcium, phosphate, and PTH were not significant.

Perioperative changes of FGF23 in patients undergoing surgery for primary hyperparathyroidism

“…Bilha et al also mentioned that some patients followed up prospectively for up to 12 months after surgery showed constant cFGF23 levels, despite PTH and calcium normalization and vitamin D replenishment. Hassani et al ( 33 ) showed positive correlation of FGF23 with 1,25(OH) 2 D preoperatively and postoperatively (24 h and 1 week after the operation), and they did not prove significant correlations between FGF23, calcium, phosphate and PTH.…”

Phosphate Metabolism and Pathophysiology in Parathyroid Disorders and Endocrine Tumors

“…Studies on the clinical role of FGF-23 in PHPT are scarce, although this hormone might have a potential role in the severity of clinical manifestations or symptoms in these patients. Twenty-nine PHPT patients were evaluated prospectively before and after parathyroidectomy [ 19 ]. The authors found that 1.25(OH) 2 vitamin D levels correlated with FGF-23 levels both preoperatively and postoperatively, although they could not find any other significant relationship with calcium, phosphate, and PTH.…”

Assessment of Clinical Utility of Assaying FGF-23, Klotho Protein, Osteocalcin, NTX, and Sclerostin in Patients with Primary Hyperparathyroidism

“…The fibroblast growth factor 23 (FGF-23) is a peptide secreted by the osteocytes and osteoblasts, at present considered to be a regulator of the calcium–phosphate balance and an important element of the FGF-23-bone–kidney axis. FGF-23 enhances urinary phosphate excretion and inhibits the production of the active form of vitamin D. The importance of FGF-23 in PHPT patients has been recently described [ 6 ].…”