Альманах клинической медицины. 2014; : 56-60
ЗНАЧЕНИЕ ВИТАМИНА D В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ГИПЕРПАРАТИРЕОЗА
https://doi.org/10.18786/2072-0505-2014-32-56-60Аннотация
Актуальность. Патофизиологическое взаимодействие между витамином D и гиперпаратиреозом находится на стадии изучения, оно никогда не исследовалось систематически и в настоящее время остается не совсем понятным. Цель – определить влияние недостатка/дефицита витамина D на клиническое течение гиперпаратиреоза, а также на до- и послеоперационный период у больных с первичным гиперпаратиреозом (ПГПТ). Материал и методы. В алгоритм лабораторного и инструментального обследования 374 пациентов с повышенным уровнем паратиреоидного гормона (ПТГ) добавлены определение уровня витамина D, проба с альфакальцидолом и тонкоигольная аспирационная пункционная биопсия с определением уровня ПТГ в смыве из иглы. Результаты. Определение уровня витамина D дает возможность дифференцировать легкую форму ПГПТ от вторичного гиперпаратиреоза на фоне недостатка/дефицита витамина D. Информация о недостатке/дефиците витамина D на дооперационном этапе у больных с ПГПТ позволяет в послеоперационном периоде прогнозировать значительное снижение уровня ионизированного кальция. Заключение. Определение уровня витамина D является необходимым компонентом лабораторной диагностики у всех пациентов с повышением уровня ПТГ. У всех пациентов с нормокальциемией, нормокальциурией и повышенным уровнем ПТГ для верификации гиперпаратиреоза необходимо использовать тест с назначением альфакальцидола. Нормокальциемический вариант ПГПТ обусловлен недостатком/дефицитом витамина D. Информация о наличии дефицита/недостатка витамина D у пациентов с ПГПТ на дооперационном этапе дает возможность предположить существенное снижение уровня ионизированного кальция в крови после паратиреоидэктомии и своевременно начать пероральное лечение гипокальциемии, а в послеоперационном периоде позволяет дифференцировать рецидив ПГПТ от недостатка/дефицита витамина D и тем самым избежать дополнительного обследования и ненужных повторных операций.
Список литературы
1. Дедов ИИ, Мазурина НВ, Огнева НА, Трошина ЕА, Рожинская ЛЯ. Нарушения метаболизма витамина D при ожирении. Ожирение и метаболизм 2011;(2):3-10. (Dedov II, Mazurina NV, Ogneva NA, Troshina EA, Rozhinskaya LYa. [Vitamin D metabolic disorders in obesity]. Ozhirenie i metabolizm. 2011;(2):3-10. Russian).
2. Рожинская ЛЯ. Современные представления об этиологии, патогенезе, клинической картине, диагностике и лечении первичного гиперпаратиреоза. Лечащий врач. 2009;(3):22-7. (Rozhinskaya LYa. [Contemporary views on etiology, pathogenesis, clinical picture, diagnosis, and treatment of primary hyperparathyroidism]. Lechashchiy vrach. 2009;(3):22-7. Russian).
3. Спиричев ВБ, Громова ОА. Витамин D и его синергисты. Земский врач. 2012;(2):33-8. (Spirichev VB, Gromova OA. [Vitamin D and its synergists]. Zemskiy vrach. 2012;(2):33-8. Russian).
4. Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, Feldman BS, Pan A, Johnson L, Crowe F, Hu FB, Franco OH. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.
5. Finkelmeier F, Kronenberger B, Köberle V, Bojunga J, Zeuzem S, Trojan J, Piiper A, Waidmann O. Severe 25-hydroxyvitamin D deficiency identifies a poor prognosis in patients with hepatocellular carcinoma – a prospective cohort study. Aliment Pharmacol Ther. 2014;39(10):1204-12.
6. Garg MK. The intestinal calcistat. Indian J Endocrinol Metab. 2013;17(Suppl1):S25-S28.
7. Hill TR, Aspray TJ, Francis RM. Vitamin D and bone health outcomes in older age. Proc Nutr Soc. 2013;72(4):372-80.
8. Nordenström E, Sitges-Serra A, Sancho JJ, Thier M, Almquist M. Vitamin D status in patients operated for primary hyperparathyroidism: comparison of patients from Southern and Northern Europe. Int J Endocrinol. 2013:164939.
9. Rastogi A, Bhadada SK, Bhansali A. Pseudoarthrosis and fracture: interaction between severe vitamin D deficiency and primary hyperparathyroidism. Singapore Med J. 2013;54(11):e224-7.
10. Rathi MS, Gonzalez S, Wright D, Ellis NR, Peacey SR. Management of hypovitaminosis D in patients with primary hyper-parathyroidism. J Endocrinol Invest. 2014. [In print].
11. Resmini G, Tarantino U, Iolascon G. Vitamin D: role and opportunity to prescribe. Aging Clin Exp Res. 2013;25 Suppl 1: S125-7.
12. Schoenmakers I, Francis RM, McColl E, Chadwick T, Goldberg GR, Harle C, Yarnall A, Wilkinson J, Parker J, Prentice A, Aspray T. Vitamin D supplementation in older people (VDOP): Study protocol for a randomised controlled intervention trial with monthly oral dosing with 12,000 IU, 24,000 IU or 48,000 IU of vitamin D₃. Trials. 2013;14:299.
13. Schöttker B, Saum KU, Perna L, Ordóñez-Mena JM, Holleczek B, Brenner H. Is vitamin D deficiency a cause of increased morbidity and mortality at older age or simply an indicator of poor health? Eur J Epidemiol. 2014;29(3):199-210.
14. Shriraam V, Mahadevan S, Anitharani M, Selvavinayagam, Sathiyasekaran B. National health programs in the field of endocrinology and metabolism – Miles to go. Indian J Endocrinol Metab. 2014;18(1):7-12.
15. Soskić S, Stokić E, Isenović ER. The relationship between vitamin D and obesity. Curr Med Res Opin. 2014;30(6):1197-9.
16. Toriola AT, Nguyen N, Scheitler-Ring K, Colditz GA. Circulating 25-hydroxyvitamin D levels and prognosis among cancer patients: a systematic review. Cancer Epidemiol Biomarkers Prev. 2014;23(6):917-933.
17. Walker MD, Cong E, Kepley A, Di Tullio MR, Rundek T, Homma S, Lee JA, Liu R, Young P, Zhang C, McMahon DJ, Silverberg SJ. Association between serum 25-hydroxyvitamin D level and subclinical cardiovascular disease in primary hyperparathyroidism. J Clin Endocrinol Metab. 2014;99(2):671-80.
Almanac of Clinical Medicine. 2014; : 56-60
VITAMIN D VALUE IN DIAGNOSIS AND TREATMENT OF HYPERPARATHYROIDISM
https://doi.org/10.18786/2072-0505-2014-32-56-60Abstract
Background: Pathophysiologic interaction between vitamin D and hyperparathyroidism (HPT) is under investigation, never being systematically studied and remaining incompletely understood till now. Aim: To define the effect of vitamin D insufficiency/deficiency on the clinical course of HPT as well as on the pre- and postoperative periods in patients with primary HPT. Materials and methods: Definition of vitamin D level, a test with alfacalcidol, and a fine-needle aspiration punction biopsy together with determination of parathyroid hormone (PTH) level in the needle lavage were included into the laboratory and instrumental examination of 374 patients with increased PTH level. Results: Definition of the vitamin D level gives a chance to differentiate between a mild form of primary HPT and secondary HPT in patients with vitamin D insufficiency/deficiency. Information on the vitamin D insufficiency/deficiency in primary HPT patients at the pre-surgical stage allows to forecast significant decrease in the ionized calcium level in the postoperative period. Conclusion: Definition of vitamin D level is a necessary component of laboratory diagnostics in all patients with a raised PTH level. Every patient with normocalcemia, normocalciuria and increased PTH level should undergo verification of HPT using the test with alfacalcidol. Normocalcemic variant of primary HPT is due to the vitamin D insufficiency/deficiency. The vitamin D insufficiency/deficiency, defined in patients at the pre-surgical stage, gives an opportunity to suggest a significant decrease in the serum ionized calcium level after parathyroidectomy and to start in time an oral treatment of hypocalcemia, providing differentiation between primary HPT recurrence and vitamin D insufficiency/deficiency in postoperative period, thereby avoiding additional observation and unjustified repeated operations.
References
1. Dedov II, Mazurina NV, Ogneva NA, Troshina EA, Rozhinskaya LYa. Narusheniya metabolizma vitamina D pri ozhirenii. Ozhirenie i metabolizm 2011;(2):3-10. (Dedov II, Mazurina NV, Ogneva NA, Troshina EA, Rozhinskaya LYa. [Vitamin D metabolic disorders in obesity]. Ozhirenie i metabolizm. 2011;(2):3-10. Russian).
2. Rozhinskaya LYa. Sovremennye predstavleniya ob etiologii, patogeneze, klinicheskoi kartine, diagnostike i lechenii pervichnogo giperparatireoza. Lechashchii vrach. 2009;(3):22-7. (Rozhinskaya LYa. [Contemporary views on etiology, pathogenesis, clinical picture, diagnosis, and treatment of primary hyperparathyroidism]. Lechashchiy vrach. 2009;(3):22-7. Russian).
3. Spirichev VB, Gromova OA. Vitamin D i ego sinergisty. Zemskii vrach. 2012;(2):33-8. (Spirichev VB, Gromova OA. [Vitamin D and its synergists]. Zemskiy vrach. 2012;(2):33-8. Russian).
4. Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, Feldman BS, Pan A, Johnson L, Crowe F, Hu FB, Franco OH. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348:g1903.
5. Finkelmeier F, Kronenberger B, Köberle V, Bojunga J, Zeuzem S, Trojan J, Piiper A, Waidmann O. Severe 25-hydroxyvitamin D deficiency identifies a poor prognosis in patients with hepatocellular carcinoma – a prospective cohort study. Aliment Pharmacol Ther. 2014;39(10):1204-12.
6. Garg MK. The intestinal calcistat. Indian J Endocrinol Metab. 2013;17(Suppl1):S25-S28.
7. Hill TR, Aspray TJ, Francis RM. Vitamin D and bone health outcomes in older age. Proc Nutr Soc. 2013;72(4):372-80.
8. Nordenström E, Sitges-Serra A, Sancho JJ, Thier M, Almquist M. Vitamin D status in patients operated for primary hyperparathyroidism: comparison of patients from Southern and Northern Europe. Int J Endocrinol. 2013:164939.
9. Rastogi A, Bhadada SK, Bhansali A. Pseudoarthrosis and fracture: interaction between severe vitamin D deficiency and primary hyperparathyroidism. Singapore Med J. 2013;54(11):e224-7.
10. Rathi MS, Gonzalez S, Wright D, Ellis NR, Peacey SR. Management of hypovitaminosis D in patients with primary hyper-parathyroidism. J Endocrinol Invest. 2014. [In print].
11. Resmini G, Tarantino U, Iolascon G. Vitamin D: role and opportunity to prescribe. Aging Clin Exp Res. 2013;25 Suppl 1: S125-7.
12. Schoenmakers I, Francis RM, McColl E, Chadwick T, Goldberg GR, Harle C, Yarnall A, Wilkinson J, Parker J, Prentice A, Aspray T. Vitamin D supplementation in older people (VDOP): Study protocol for a randomised controlled intervention trial with monthly oral dosing with 12,000 IU, 24,000 IU or 48,000 IU of vitamin D₃. Trials. 2013;14:299.
13. Schöttker B, Saum KU, Perna L, Ordóñez-Mena JM, Holleczek B, Brenner H. Is vitamin D deficiency a cause of increased morbidity and mortality at older age or simply an indicator of poor health? Eur J Epidemiol. 2014;29(3):199-210.
14. Shriraam V, Mahadevan S, Anitharani M, Selvavinayagam, Sathiyasekaran B. National health programs in the field of endocrinology and metabolism – Miles to go. Indian J Endocrinol Metab. 2014;18(1):7-12.
15. Soskić S, Stokić E, Isenović ER. The relationship between vitamin D and obesity. Curr Med Res Opin. 2014;30(6):1197-9.
16. Toriola AT, Nguyen N, Scheitler-Ring K, Colditz GA. Circulating 25-hydroxyvitamin D levels and prognosis among cancer patients: a systematic review. Cancer Epidemiol Biomarkers Prev. 2014;23(6):917-933.
17. Walker MD, Cong E, Kepley A, Di Tullio MR, Rundek T, Homma S, Lee JA, Liu R, Young P, Zhang C, McMahon DJ, Silverberg SJ. Association between serum 25-hydroxyvitamin D level and subclinical cardiovascular disease in primary hyperparathyroidism. J Clin Endocrinol Metab. 2014;99(2):671-80.
