Endocrine Abstracts (2013) 32 P129 | DOI: 10.1530/endoabs.32.P129

Does recognition of vitamin D deficiency affect the indication for surgical treatment in asymptomatic primary hyperparathyroidism?

Laura Gianotti, Francesco Tassone, Micaela Pellegrino, Claudia Baffoni, Sara Cassibba, Gianpaolo Magro, Flora Cesario & Giorgio Borretta


S. Croce and Carle Hospital, Cuneo, Italy.


Introduction: Current guidelines for the management of asymptomatic primary hyperparathyroidism (A-pHPT) recommend that 25-hydroxyvitamin D levels should be assessed in all patients and vitamin D deficiency (VDD) should be cautiously corrected. It is unknown whether VDD affects the probability to meet surgical criteria currently proposed for A-pHPT. Aim of study was to evaluate whether VDD recognition affects the probability to meet surgical criteria in A-pHPT patients.

Methods: Eighty consecutive A-pHPT patients were studied (mean±S.D. age: 66.5±8.9 years; male/female=10/70; PTH: 179.8±134.7 ng/l, calcium: 10.8±0.7 mg/dl; ionized calcium: 1.39±0.10 mmol/l; 25OHD: 30.0±21.3 ng/ml). VDD was defined as 25-hydroxyvitamin D <20 ng/ml. The criteria for surgery of III International Workshop on the Management of ApHPT were considered, i.e.: Serum calcium >1 mg/dl the upper normal limit; creatinine clearance <60 ml/min; T-score <−2.5 at any site.

Results: VDD was present in 32 patients (40%). A-pHPT patients with VDD showed higher PTH (P=0.0007), total (P=0.04) and ionized calcium (P=0.013) and lower forearm T-score (P=0.019) compared with A-pHPT without VDD. No difference in fulfillment of any surgical criteria was present between A-pHPT patients with or without VDD (calcium criterion=25 vs 14.6%, P=0.2586; eGFR criterion =19.4 vs 21.7%, P=1.000; T-score criterion=78.1 vs 64.6%, P=0.2226, respectively).

Conclusion: VDD is not rarely detected in A-pHPT and affects biochemical and densitometric features; however, the recognition of VDD does not affect the probability to meet surgical criteria proposed by current guidelines in A-pHPT. Thus, the assessment of vitamin D status, as recommended, does not affect the therapeutical choice for surgery in A-pHPT.