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PRİMER HİPERPARATİROİDiDE, PARATİROİD ADENOM AĞIRLIĞI İLE PREOPERATİF BİYOKİMYASAL PARAMETRELER ARASINDAKİ İLİŞKİ

RELATIONSHIP BETWEEN ADENOMAWEIGHT AND PREOPERATIVE BIOCHEMICAL PARAMETERS IN PRIMARY HYPERPARATHYROIDISM

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2006

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective:The aim of this study was to determine the relationships between parathyroid adenoma weight and preoperative biochemical indices such as parathyroid hormone, calcium, phosphate, alkaline phosphatase, and urinary calcium excretion in patients with primary hyperparathyroidism. Materials and methods: Forty five patients with primary hyperparathyroidism followed-up between the years 1996 and 2005 in our endocrinology clinic in whom the presence of parathyroid adenoma was histopathologically confirmed after the surgical excision were included in this retrospective study. Patients with high creatinin levels, multiple endocrine neoplasia syndrome, and with parathyroid cancer and those with parathyroid hyperplasia were exluded. The biochemical parameters in the patients were recorded and the relationship between parathyroid adenoma weight and those parameters was statistically analyzed using the Pearson bivariate correlation analysis.Results: The mean age of study group was 52.7 years. The preoperative laboratory evaluation revealed the following findings: Serum calcium concentrations (Ca): 11.8 ± 1.0 mg/dL (range:10.1-15.4; normal: 8.5-10.5); phosphate (P): 2.3 ± 0.51 mg/dL (range 1.2-3.5; normal: 2.7-4.5); alkaline phosphatase (ALP): 332.0 ± 199 U/L (range: 80-1143; normal:90-260); 25-hydroxy-vitamin D (25(OH)D3): 24.9 ± 23.5 ng/mL (range: 5-101; normal>20); parathyroid hormone (PTH): 376 ± 389 pg/mL (range: 65-1562; normal 10-65) and urinary calcium excretion: 523 ± 185 mg/24 h (range: 98-850; normal:<300). The mean weight of the excised parathyroid adenomas was 1098 ± 804 mg. A significant positive correlation was observed between parathyroid adenoma weight and serum calcium concentrations (r=0.33, p<0.05). Serum 25(OH)D3 concentrations correlated significantly and negatively with parathyroid adenoma weight (r=-0.46, p<0.01). PTH and ALP correlated significantly and negatively with 25(OH)D3 (r=-0.29, p<0.05 and r=-0.36, p<0.05 respectively). A significant positive correlation was observed between PTH and ALP(r=0.50, p=0.001). No significant correlations were observed between the adenoma weight and PTH, ALP, P, and urinary calcium excretion. Conclusion: Significant positive correlation between parathyroid adenoma weight and serum calcium concentrations observed in this study indicates that parathyroid adenoma weight may affect the clinical and laboratory presentation of the disease. Significant negative correlation between parathyroid adenoma weight and 25(OH)D3 concentrations indicates increased parathyroid tumor growth in vitamin D deficiency states leading to more severe forms of the disease besides well-known normocalcemic forms.
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Abstract (Original Language): 
Amaç: Primer hiperparatiroidizmli hastalarda klinik belirti ve bulgular hastadan hastaya farkl›l›klar göstermektedir. Bu çal›flmada, paratiroid adenom a¤›rl›¤› ile ameliyat öncesi tespit edilen serum parathormon (iPTH), kalsiyum (Ca), fosfor (P), alkalen fosfataz (ALP), 25-hidroksivitamin D (25(OH)D3) ve üriner kalsiyum at›l›m› gibi biyokimyasal parametreler aras›nda iliflki olup olmad›¤›n›n tespiti amaçland›. Gereç ve yöntem: Bu retrospektiv araflt›rmada, endokrinoloji poliklini¤imizce 1996 – 2005 y›llar› aras›nda takip edilen, histopatolojik olarak paratiroid adenomu tan›s› do¤rulanm›fl 45 hasta çal›flmaya al›nd›. Yüksek kreatinin düzeyleri, multiple endokrin neoplazi sendromu, paratiroid karsinomu olanlar ve patolojik incelemede paratiroid hiperplazisi tespit edilenler çal›flmaya al›nmad›. Hastalar›n iPTH, Ca, ALP, 25(OH)D3 ve 24 saatlik üriner kalsiyum at›l›m› kaydedildi. Pearson ‘bivariate’ korelasyon analizi yöntemiyle istatistiksel analiz yap›ld›. Bulgular: Yafl ortalamas› 52,7 y›l (23-76) olan 45 hastan›n laboratuvar incelemelerinde; operasyon öncesi dönemde ortalama Ca:11,8 ± 1,0 mg/dL (aral›k:10,1-15,4; normal: 8,5-10,5), P: 2,3 ± 0,5 mg/dL (aral›k:1,2-3,5; normal: 2,7-4,5), ALP:332 ± 199 U/L (aral›k: 80-1143; normal:90-260), 25(OH)D3:24,9 ± 23,5 ng/mL (aral›k: 5-101; normal> 20), PTH: 376 ± 389 pg/mL (aral›k: 65-1562; normal 10-65) ve idrar kalsiyum at›l›m› 523 mg/24 saat (aral› k:98-850; normal:<300) olarak tespit edildi. Paratiroid adenomlar›n›n ortalama a¤›rl›¤› 1098 ± 804 mg (110- 3600)’d›. Adenom a¤›rl›¤› ile serum kalsiyum konsantrasyonlar› aras›nda anlaml› pozitif korelasyon (r=0,33, p<0,05) ve 25(OH)D3 konsantrasyonlar› aras›nda anlaml› negatif korelasyon (r=-0,43, p<0,01) tespit edildi. Ayr›ca 25(OH)D3 ile PTH (r=-0,29, p<0,05) ve ALP(r=-0,36, p<0,05) aras›nda anlaml› negatif korelasyon, PTH ile ALP konsantrasyonlar› aras›nda anlaml› pozitif bir korelasyon (r=0,50, p=0,001) saptand›. Sonuç: Çal›flmam›zda paratiroid adenomu a¤›rl›¤› ile serum kalsiyum konsantrasyonlar› aras›ndaki pozitif korelasyon, adenom a¤›rl›¤›n›n, hastal›¤›n laboratuvar ve klinik prezentasyonunu etkiledi¤ini göstermektedir. Paratiroid adenomu a¤›rl›¤› ve 25(OH)D3 düzeyi aras›ndaki negatif korelasyon, D vitamini eksikli¤inin yayg›n olarak görüldü¤ ü ülkemiz için kayda de¤er bir bulgudur. D vitamini eksikli¤i, ülkemizde, asemptomatik primer hiperparatiroidi yan›nda, ciddi klinik bulgularla baflvuran vakalar›n s›k olarak görülmesine katk›da bulunabilir.
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  • Turkish

REFERENCES

References: 

1- Alagöl F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli
H, Sandalci O. Sunlight exposure and vitamin D deficiency
in Turkish women. J Endocrinol Invest 2000; 23:173-177.
2- Bilezikian JP, Potts JT, Fuleihan GH, Kleerekoper M, Neer R,
Peacock M, Rastad J, Siverberg SJ, Udelsman R, Wells SA.
Summary statement from a workshop on asymptomatic primary
hyperparathyroidism. A perspective for the 21st century. J Clin
Endocrinol Metab 2002;87:5353-5361.
3- Bindlish V, Freeman JL, Witterick IJ, Asa SL. Correlation of biochemical
parameters with single parathyroid adenoma weight
and volume. Head Neck 2002;24:1000-1003.
4- Boonen S, Vanderschueren D, Pelemans W, Bouillon R. Primary
hyperparathyroidism: diagnosis and management in the older individual.
Eur Endocrino 2004;151:297-303.
5- Clements MR, Davies M, Hayes ME, Hickey CD, Lumb GA,
Mawer EB, Adams PH. The role of 1,25-dihydroxyvitamin D in
the mechanism of acquired vitamin D deficiency. Clin Endocrinol
(Oxf) 1992;37:17–27.
6- Harinarayan DV, Gupta N, Kochupillai N. Vitamin D status in
primary hyperparathyroidism in India. Clin Endocrinol (Oxf)
1995; 43:351–358.
7- Kleeman CR, Norris K, Coburn JW. Is the clinical expression of
primary hyperparathyroidism a function of the long-term vitamin
D status of the patient? Miner Electrolyte Metab
1987;13:305–310.
8- Locchi F, Tommasi M. Brandi ML, Tonelli F, Meldolesi U. A
controversial problem: is there a relationship between parathyroid
hormone level and parathyroid size in primary hyperparathryoidism.
Int J Biol Markers 1997;12:106 –111.
9- Lumb GA, Stanbury SW. Parathyroid function in human vitamin
D deficiency and vitamin D deficiency in primary hyperparathyroidism.
Am J Med 1974:56:833– 839.
10- Mozes G, Curlee KJ, Rowland CM, Heerden JA, Thompson
GB, Grant CS, Farley DR. The predictive value of laboratory
findings in patients with primary hyperparathyroidism. J Am
Coll Surg 2002;194:126-130.
11- Parfitt AM. Parathyroid growth: normal and abnormal. In: Bilezikian
JP, Levine MA, Marcus R (eds.) The parathyroids: basic
and clinical concepts. Raven Pres, New York, USA 1994,
pp.373–405.
12- Rao DS. Primary hyperparathyroidism: changing patterns in presentation
and treatment decisions in the eighties. Henry Ford
Hosp Med J 1985;33:194-197.
13- Rao DS, Honasoge M, Divie GW, Phillips ER, Lee MW, Ansari
MR, Talpos GB, Parfitt AM. Effect of vitamin D nutrition on
parathyroid adenoma weight: pathogenetic and clinical implications.
J Clin Endocrinol Metab 2000;85:1054-1058.
14- Rao DS, Phillips E, Honasoge M, Mithal A, Mishra SC, Sing
AK. Role of vitamin D nutrition in primary hyperparathyroidism:
effect on parathyroid gland mass and on bone. In: Norman
AW, Boullion R, Thomasset M, (eds.) Vitamin D: chemistry,
biology, and clinical applications of the steroid hormone.
Riverside: University of California; 1997:pp.723–724.
15- Rao DS, Agarwal G, Talpos GB, Phillips ER, Bandeira F, Mishra
SK, Mithal A. Role of vitamin D and calcium nutrition in disease
expression and parathyroid tumor growth in primary
hyperparathyroidism:a global perspective. J Bone Miner Res
2002;17(suppl 2): 75-80.
16- Silverberg SJ, Shane E, Dempster DW, Bilezikian JP. The effects
of vitamin D insufficiency in patients with primary hyperparathyroidism.
Am J Med 1999;107: 561-567.
17- Siverberg SJ, Blezikian JP. Incipient primary hyperparathyroidism:
a forme fruste of an old disease. J Clin Endocrinol Metab
2003; 88:5348-5352.
18- Williams JG, Wheeler MH, Aston JP, Brown RC, Woodhead JS.
The relationship between adenoma weight and intact (1-84) parathyroid
hormone level in primary hyperparathyroidism Am J
Surg 1992;163:301-304.
19- Woodhouse, NJY, Doyle FH, Joplin GF. Vitamin-D deficiency,
and primary hyperparathyroidism. Lancet 1971;2:283–287.
20- Yamashita H, Noguchi S, Uchino S, Watanebe S, Koike E, Murakami
T, Fujihira T, Koga Y, Masatsugu T, Yamashita H. Vitamin
D status in Japanese patients with hyperparathyroidism: seasonal
changes and effect of clinical presentation. World J Surg
2002;26: 937-941.

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