Substrate-Product Relation of 1-Hydroxylase Activity in Primary Hyperparathyroidism

LoCascio, V.; Adami, Silvano; Galvanini, G.; Ferrari, Marcello; Cominacini, Luciano; Tartarotti, D.

doi:10.1056/nejm198510313131804

Cited by 41 publications

(27 citation statements)

References 10 publications

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“…It appears that a preoperative treatment with D 3 (64,65) and calcifediol (68) decreases circulating plasma PTH levels in VitD insufficient patients with PHPT, whereas D 2 appears to be less effective (66,67). The effects on bone markers and BMD are not conclusive.…”

Section: The Benefits and Risks Of Vitd Repletion In Mild Phptmentioning

confidence: 99%

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Bollerslev

Marcocci

Sosa

et al. 2011

European Journal of Endocrinology

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Management of patients with mild primary hyperparathyroidism (PHPT) has been widely discussed because most patients today do not have specific symptoms. While surgery is always an option, the recommendations for treatment have shifted, which mostly reflects changes in clinical practice. In this study, we aimed to evaluate evidence for the current recommendations concerning operation vs observation, repletion with vitamin D (VitD) and alternative medical management.Surgery is followed by normalisation of calcium and parathyroid hormone (PTH) and a decrease in bone turnover followed by an increase in bone mass. It is not known what the consequences would be for the frequency of fractures. Randomised studies have indicated beneficial effects of operation on quality of life (QoL), but the effects have been minor and inconsistent. Operation seems not to be superior to observation for cardiovascular risk factors. Although PHPT patients in average have slightly decreased plasma 25OH VitD, severe symptomatic VitD deficiency seems not to be a characteristic of PHPT patients in Europe. However, if present, we recommend VitD substitution before final decision on surgical treatment. It is unknown whether routine VitD supplementation should be offered preoperatively to all patients with mild PHPT or as part of long-term medical treatment.Targeted medical management could be an option for patients with contraindications to surgery. Antiresorptive therapy might be appropriate for patients with a low bone mass to prevent further bone loss. Calcimimetics could be tried to control serum calcium levels although there is no evidence of an effect on the hypercalcaemic symptoms or the QoL. Combined therapy with calcimimetics and alendronate could be considered for patients with hypercalcaemia and overt bone disease.

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Section: The Benefits and Risks Of Vitd Repletion In Mild Phptmentioning

confidence: 99%

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Bollerslev

Marcocci

Sosa

et al. 2011

European Journal of Endocrinology

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“…When a normal amount of 25OHD is present in the blood, a large increase of this metabolite as achieved by high doses of exogenous 25OHD, is thought not to influence circulating 1,25(OH) 2 D. This has been shown in experimental animals [1,2] and in small numbers of young subjects [3,4], the explanation being that elevated levels of 25OHD increase the metabolic clearance rate of 1,25(OH) 2 D [2]. Conversely, there are several reports of a significant response of 1,25(OH) 2 D to 25OHD in normal children [5], postmenopausal women [6,7], normal aging [8], and normal adults who have undergone ultraviolet radiation [9].…”

Section: Introductionmentioning

confidence: 97%

Vitamin D substrate–product relationship in idiopathic hypercalciuria

Bevilacqua

Gandolini

et al. 2009

The Journal of Steroid Biochemistry and Molecular Biology

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“…In consequence, plasma 1a,25-dihydroxyvitamin D (P-1,25(OH) 2 D) is usually high normal or elevated in primary hyperparathyroidism (PHPT) (3)(4)(5), although low levels have also been reported depending on available plasma 25-hydroxyvitamin D (P-25OHD), renal function and the degree of hypercalcaemia (3,4,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study

Moosgaard¹,

Vestergaard²,

Heickendorff³

et al. 2006

eur j endocrinol

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Background: Primary hyperparathyroidism (PHPT) is associated with reduced plasma 25-hydroxyvitamin D (P-25OHD) and usually increased plasma 1a,25-dihydroxyvitamin D (P-1,25(OH) 2 D). Parathyroid tissue expresses the vitamin D receptor and it is thought that circulating 1,25(OH) 2 D participate in the regulation of parathyroid cell proliferation, differentiation and secretion. Aim: To investigate the relations between circulating levels of 1,25(OH) 2 D and 25OHD respectively and parathyroid adenoma weight (AW), plasma-parathyroid hormone (P-PTH) and PTH secretion expressed as P-PTH/AW. Design: Cross-sectional study. Material: One hundred and seventy-one consecutive hypercalcaemic caucasian patients aged 19-87 years (median 63, 84% females) with surgically proven parathyroid adenoma. Results: A weak positive correlation was found between P-25OHD and P-1,25(OH) 2 D (rZ0.24, P!0.005). AW depended on sex and body mass index. Following adjustment, it was correlated positively to P-PTH, calcium (Ca) and alkaline phosphatase (AP) and inversely to plasma phosphate in a multiple regression model. AW was not associated with vitamin D metabolites. Preoperative P-PTH correlated positively to plasma levels of Ca and AP, but inversely to phosphate and 25OHD (P!0.001) levels. P-PTH was not associated with P-1,25(OH) 2 D (PZ0.65). The P-PTH:AW ratio correlated inversely to P-25OHD (P!0.05), but showed no relations to plasma levels of Ca, phosphate or 1,25(OH) 2 D (PZ0.22). Conclusion: In this material, low levels of 25OHD were related to higher levels of P-PTH and higher PTH:AW ratios in patients with PHPT suggesting that vitamin D deficiency increase PTH secretion activity. Neither PTH secretion nor AW was associated with circulating levels of 1,25(OH) 2 D.

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Substrate-Product Relation of 1-Hydroxylase Activity in Primary Hyperparathyroidism

Cited by 41 publications

References 10 publications

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism

Vitamin D substrate–product relationship in idiopathic hypercalciuria

Plasma 25-hydroxyvitamin D and not 1,25-dihydroxyvitamin D is associated with parathyroid adenoma secretion in primary hyperparathyroidism: a cross-sectional study

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