The importance of hypophosphatemia in the clinical management of primary hyperparathyroidism

Duger, Hakan; Bostan, H; Gül, Ü; Uçan, Bekir; Hepşen, S; Sakız, Davut; Akhanlı, P; Çakal, Erman; Kızılgül, Muhammed

doi:10.1007/s40618-023-02064-w

Cited by 4 publications

(10 citation statements)

References 19 publications

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“…In our study, PHPT severity in terms of biochemical indicators (high serum Ca, UCa, and PTH levels) was worse in hypoP patients than a normal level; however, severe PHPT was not associated with renal stones. These findings are consistent with those of Castellano et al [ 9 ] and Düger et al [ 10 ]. In fact, Castellano et al stated that a gender-dragging effect cannot be ruled out because renal stones are generally more frequent in males with PHPT [ 24 ].…”

Section: Discussionsupporting

confidence: 94%

“…Although every clinician considers serum P levels when assessing PHPT, the guidelines do not mention a cut-off value because serum P levels are normal in most PHPT patients [ 9 , 10 ]. In our study, serum P levels were normal in 64% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is rare for an individual to have PHPT and an FGF23-mediated disorder [ 15 ]. Previous studies have shown that 25OHD levels are even lower in patients with hypoP with PHPT [ 9 , 10 , 19 ]. In our study, 25OHD levels were lower in mild and moderate hypoP patients than non-hypoP patients and associated with higher serum Ca levels, i.e., severe PHPT, which is in line with the findings of other studies [ 9 , 10 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have investigated the relationship between the laboratory and clinical symptoms of PHPT and hypophosphatemia (hypoP). Two recent studies have emphasized that the presence of hypoP in PHPT cases is biochemically and clinically very important [ 9 , 10 ]. These studies recommended simultaneous routine monitoring of serum P, PTH, and Ca levels in PHPT patients and noted that moderate hypoP should be a criterion for parathyroidectomy in asymptomatic PHPT patients aged over 50 years old with a mildly increased serum Ca level [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Moderate Hypophosphatemia on the Clinical Management of Primary Hyperparathyroidism

Güneş,

Güneş

2023

Cureus

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Background and objective The impact of moderate hypophosphatemia (hypoP) on primary hyperparathyroidism (PHPT) and its use as an independent surgical criterion has not been adequately evaluated in the literature. In light of this, we conducted this study to address the scarcity of data on this topic. Methods We conducted a retrospective evaluation of data related to 164 (133 females and 31 males) patients with PHPT who met the criteria for inclusion in the study. HypoP, which is indicated by phosphorus (P) levels lower than 2.5 mg/dL, was found in 78 (47.5%) patients, and moderate hypoP (1-1.99 mg/dL) was found in 25 patients (15.2%). Results PHPT severity was worse in hypoP patients than non-hypoP patients, as evidenced by higher levels of mean serum calcium (12.9 ±1.0 mg/dL vs. 11.1 ±0.3 mg/dL respectively, p<0.001), parathormone (PTH) [median (interquartile range, IQR): 455.3 (455.3) ng/L vs. 124.0 (84.0) ng/L respectively, p<0.001] and mean 24-hour urinary calcium (414.6 ±168.5 mg/day vs. 291.5 ±161.4 mg/day respectively, p=0.026) as well as lower levels of mean BMI (25.6 ±3.9 kg/m 2 vs. 29.0 ±4.0 kg/m 2 respectively, p=0.18) and mean 25-hydroxy vitamin D3 (13.8 ±7.3 µg/L vs. 18.2 ±7.8 µg/L respectively, p=0.001). Among the whole study population as well as among patients with Ca levels <1.0 mg/dL according to the upper limit of normal, P level was determined to be an independent factor affecting the indication for surgical treatment [β: -1.96,p=0.038, odds ratio (OR): 0.14, 95% confidence interval (CI): 0.02-0.89 and β: -2.3, p=0.034, OR: 0.10, 95% CI: 0.12-0.84 respectively]. Conclusion We found a strong correlation between moderate hypoP and the severity of the biochemical manifestations of PHPT. In asymptomatic PHPT patients, moderate hypoP was predictive of surgical indication, independent of age and level of hypercalcemia.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Moderate Hypophosphatemia on the Clinical Management of Primary Hyperparathyroidism

Güneş,

Güneş

2023

Cureus

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“…Previous studies have documented that PHPT is characterized by hypercalcemia and elevated or abnormal PTH levels. Additionally, serum phosphate levels in patients with PHPT are commonly low or abnormal and demonstrate an inverse correlation with PTH levels ( 27 ). The underlying mechanism may be the activation of the calcium-sensitive receptor (CaSR) found on cell membranes.…”

Section: Discussionmentioning

confidence: 99%

Assessing causal associations of hyperparathyroidism with blood counts and biochemical indicators: a Mendelian randomization study

Jiang,

Chen,

et al. 2023

Front. Endocrinol.

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BackgroundThe existing literature on the relationship of hyperparathyroidism with both blood counts and biochemical indicators primarily comprises observational studies, which have produced inconsistent findings. This study aimed to evaluate the causal relationship between hyperparathyroidism and blood counts and biochemical indicators.MethodsMendelian randomization (MR) analyses were conducted to investigate the associations between hyperparathyroidism and the identified 55 blood counts and biochemical indicators. The genome-wide association study (GWAS) for hyperparathyroidism data was obtained from FinnGen, while the GWASs for the blood counts and biochemical indicators were sourced from the UK Biobank (UKBB).ResultsThe MR analysis using the inverse-variance weighted (IVW) method revealed potential causality between genetically predicted hyperparathyroidism and seven out of 55 blood counts and biochemical indicators. These markers include “Platelet count” (Beta = -0.041; 95% CI: -0.066, -0.016; p = 0.001), “Platelet distribution width (PDW)” (Beta = 0.031; 95% CI: 0.006, 0.056; p = 0.016), “Mean platelet volume (MPV)” (Beta = 0.043; 95% CI: 0.010, 0.076; p = 0.011), “Vitamin D” (Beta = -0.038; 95% CI: -0.063, -0.013; p = 0.003), “Calcium (Ca2+)” (Beta = 0.266; 95% CI: 0.022, 0.509; p = 0.033), “Phosphate” (Beta = -0.114; 95% CI: -0.214, -0.014; p = 0.025), and “Alkaline phosphatase (ALP)” (Beta = 0.030; 95% CI: 0.010, 0.049; p = 0.003).ConclusionThe findings of our study revealed a suggestive causal relationship between hyperparathyroidism and blood cell count as well as biochemical markers. This presents a novel perspective for further investigating the etiology and pathological mechanisms underlying hyperparathyroidism.

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Calcium/phosphate ratio: an additional tool for the clinical management of asymptomatic primary hyperparathyroidism?

Castellano,

Attanasio,

Boriano

et al. 2023

J Endocrinol Invest

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The importance of hypophosphatemia in the clinical management of primary hyperparathyroidism

Cited by 4 publications

References 19 publications

The Impact of Moderate Hypophosphatemia on the Clinical Management of Primary Hyperparathyroidism

The Impact of Moderate Hypophosphatemia on the Clinical Management of Primary Hyperparathyroidism

Assessing causal associations of hyperparathyroidism with blood counts and biochemical indicators: a Mendelian randomization study

Calcium/phosphate ratio: an additional tool for the clinical management of asymptomatic primary hyperparathyroidism?

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