Effect of vitamin D nutrition on disease indices in patients with primary hyperparathyroidism

Rao, Sudhaker D; Miragaya, Joanna; Parikh, Nayana; Honasoge, Mahalaksmi; Springer, Kylie; Harn, Meredith Van; Divine, George

doi:10.1016/j.jsbmb.2020.105695

Cited by 11 publications

(18 citation statements)

References 33 publications

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“…The relationship between adenoma size and serum 25hydroxyvitamin D levels in the 2 cohorts are shown in Figure 2. There was an inverse relationship between the adenoma size and serum 25-hydroxyvitamin D level in the Detroit cohort similar to our previous reports (7,25), but not in the Indian cohort. Also, for any given level of serum 25-hydroxyvitamin D level, Indian PHPT patients had larger adenomas compared to the Detroit PHPT patients, which may explain the lack of expected inverse relationship between these two variables in the Indian cohort or obscured by the additional effect of low calcium intake in the Indian population (28).…”

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confidence: 90%

“…Among these 3 variants, atypical parathyroid adenomas (now reclassified as atypical parathyroid tumors) are the most studied because of their shared histological and genetic features with benign and malignant parathyroid tumors (4). In an earlier era, osteitis fibrosa cystica (OFC), the specific bone lesion due to excess parathyroid hormone (PTH) secretion was an important diagnostic clue to the presence of primary hyperparathyroidism (PHPT) and was almost always associated with large parathyroid adenomas and vitamin D and calcium deficiency (6)(7)(8)(9). OFC also occurs in both renal and non-renal secondary hyperparathyroidism (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Large parathyroid adenomas: Potential mechanisms to reconcile adenoma size and disease phenotype

Bhan

Athimulam²,

Kumari³

et al. 2023

Front. Endocrinol.

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Parathyroid adenomas weighing more than 3.5 g are reported variously as “atypical”, “large” or “giant” parathyroid adenomas. All such adenomas are rare variants accounting for no more than 1.5% of all parathyroid adenomas. Large parathyroid adenomas are often associated with more severe form of the disease, including osteitis fibrosa cystica (OFC) and share many biochemical, histological, and molecular features of both benign and malignant parathyroid neoplasms, and are considered a distinct clinical entity. However, the pathogenesis of oversized parathyroid adenomas and the often-associated skeletal phenotype remains unclear. We present 5 cases of primary hyperparathyroidism (PHPT) with OFC, an uncommon manifestation of contemporary PHPT, associated with larger parathyroid adenomas, seen in the Bone and Mineral Disorders Clinic of the Henry Ford Health in the last 30 years to illustrate the critical role of vitamin D nutrition in the pathogenesis of both the OFC and adenoma size. The estimated prevalence of OFC was very low 0.2%, 5 of the >3000 surgically confirmed cases of PHPT seen during this time. The mean ± SD values were: age: 36.8 ± 22.1 years (4 of the 5 <36years), serum calcium 11.6 ± 1.1 mg/dl, alkaline phosphatase 799 ± 487 IU/L, PTH 1440 ± 477 pg/ml, 25-hydroxyvitamin D 13.0 ± 8.9 ng/ml, 1,25-dihyroxyvitamin D 26.5 ± 13.7 pg/ml, urine calcium 562 ± 274 mg/day, and parathyroid adenoma weight 4.53 ± 2.2 g. Parathyroidectomy led to the resolution of both the biochemical indices and OFC in each patient without recurrence over >10 years of follow-up. Because OFC is a very rare in the West, but very common areas of endemic vitamin D deficiency, we also examined the relationship between vitamin D nutrition, as assessed by serum 25-hydroxyvitamin D level, and parathyroid adenoma weight as well as prevalence of OFC in two large secularly diverse cohorts of patients with PHPT (Detroit, USA and Chandigarh, India). Based on this relationship and the relative prevalence of OFC in these two large cohorts, we propose that vitamin D nutrition (and perhaps calcium nutrition) best explains both the adenoma size and prevalence of OFC.

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Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Large parathyroid adenomas: Potential mechanisms to reconcile adenoma size and disease phenotype

Bhan

Athimulam²,

Kumari³

et al. 2023

Front. Endocrinol.

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“…The organization gave a forum and intellectual support in India and initially in the USA to support the collaborative research enterprise. The global collaborative efforts led to the development of guidelines specific to Asian Indians with respect to calcium and vitamin D intakes,[ 23 ] country-specific bone mineral density (BMD) thresholds for the detection and diagnosis of osteopenia and osteoporosis,[ 24 25 ] the role of vitamin D in the pathogenesis and disease expression of PHPT,[ 26 ] and more recently the molecular basis for parathyroid adenoma formation. [ 27 28 ] The recent publication of the CUBES results will have far-reaching clinical implications for the diagnosis and treatment of osteoporosis.…”

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confidence: 99%

“…[ 24 ] The CUBES study and similar other studies, including the multicenter Indian Council of Medical Research (ICMR) funded study, highlighted the challenges the patients and health care providers face when applying the non-Indian databases in making clinical decisions for long term treatments. Similarly, studies linking vitamin D nutrition and the clinical expression of parathyroid disease eventually could eliminate bone disease and osteitis fibrosa cystica in PHPT,[ 20 21 26 ] just as iodination of salt eliminated endemic goiter. Several ISBMR researchers contributed immensely to our understanding of the similarities and differences in disease expression between countries and within India.…”

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Endocrinologists of Indian Origin: A Global Force that can (and should) Collaborate

Gossain¹,

Rao

2022

Indian Journal of Endocrinology and Metabolism

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Pediatric Primary Hyperparathyroidism: Experience in a Tertiary Care Referral Center in a Developing Country Over Three Decades

et al. 2020

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Background There is limited experience in managing pediatric primary hyperparathyroidism (PHPT). The aim of this study was to analyze the clinical presentation and outcome of surgery in children with PHPT managed at a tertiary referral center. Methods This retrospective study (September 1989–August 2019) consisted of 35 pediatric PHPT patients (< 18 years) who underwent parathyroidectomy. Clinico‐pathologic profile and outcome were noted. Results The mean age of cohort was 15.2±2.9 years and girls outnumbered boys (M:F = 1:1.9). Familial and symptomatic disease was noted in 8.5 and 94.3% cases, respectively. Skeletal manifestations (83%) were the commonest followed by renal (29%). Fifty‐four percent children had skeletal fractures, and 23% were bed‐ridden. Among rare manifestations, hypercalcemic crisis, recurrent pancreatitis and stigmata of rickets were observed in 2.8, 11.4 and 14.2% children, respectively. Mean calcium concentration was 12.1 ± 2.0 mg/dl and PTH 91.8 ± 66.5 pmol/L. The sensitivity of preoperative imaging in parathyroid localization was 91.4%. Minimally invasive parathyroidectomy (MIP) was performed in 40% cases. Parathyroid adenoma was observed in 91.4% patients, whereas remaining had hyperplasia. Thirty‐four percent suffered from Hungry bone syndrome in postoperative period. The cure rate following primary surgery was 97%. One child with persistent PHPT had successful re‐operation. Median follow‐up was 5 (1–17) years, and no recurrence or familial disease was revealed during this period. Conclusion Majority of pediatric patients present with symptomatic PHPT. Despite relatively high incidence of familial disease select pediatric patients can undergo successful MIP.

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Effect of vitamin D nutrition on disease indices in patients with primary hyperparathyroidism

Cited by 11 publications

References 33 publications

Large parathyroid adenomas: Potential mechanisms to reconcile adenoma size and disease phenotype

Large parathyroid adenomas: Potential mechanisms to reconcile adenoma size and disease phenotype

Endocrinologists of Indian Origin: A Global Force that can (and should) Collaborate

Pediatric Primary Hyperparathyroidism: Experience in a Tertiary Care Referral Center in a Developing Country Over Three Decades

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