URINARY CALCIUM EXCRETION IN PRIMARY HYPERPARATHYROIDISM: RELATIONSHIP TO 25-HYDROXYVITAMIN D STATUS

2005 ◽  
Vol 11 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Aaron D. Bussey ◽  
Jan M. Bruder
Keyword(s):  
Primary Hyperparathyroidism ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

scholarly journals Combined vitamin D and calcium supplementation in vitamin D inadequate patients with urolithiasis: Impact on hypercalciuria and de novo stone formation

2015 ◽  
Vol 9 (11-12) ◽  
pp. 403 ◽  
Author(s):  
Charles Hesswani ◽  
Yasser A Noureldin ◽  
Mohamed A Elkoushy ◽  
Sero Andonian
Keyword(s):  
Vitamin D ◽  
De Novo ◽  
Stone Formation ◽  
Calcium Supplementation ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Hydroxyvitamin D ◽  
History Of ◽  
25 Hydroxyvitamin D

<p><strong>ABSTRACT </strong></p><p><strong>Introduction</strong>: We examined the effect of combined vitamin D and calcium supplementation (VDCS) on urinary calcium excretion and de novo stone formation in vitamin D inadequate (VDI) urolithiasis patients.</p><p><strong>Methods</strong>: We retrospectively reviewed the data of VDI patients (serum 25-hydroxyvitamin D&lt;75 nmol/L) followed at a tertiary stone centre between September 2009 and December 2014. VDI patients with history of urolithiasis, who were placed on VDCS for abnormal bone mineral density or hyperoxaliuria, were included. Hypercalciuric patients and patients on thiazide diuretics were excluded. Metabolic stone workup and two 24-hour urine collections were performed before and after VDCS.</p><p><strong> Results</strong>: In total, we inculded 34 patients, with a mean age of 54.8 years and a mean body mass index of 25.7 kg/m2. After VDCS, there was a significant increase in the mean serum 25-hydroxyvitamin D (52.0 vs. 66.4 nmol/L, p&lt;0.001) and the mean urinary calcium excretion (3.80 vs. 5.64 mmol/d, p&lt;0.001). Eight (23.5%) patients developed de novo hypercalciuria. After a median follow-up of 39 (range: 7-60) months, 50% of hypercalciuric patients developed stones compared with 11.5% of non-hypercalciuric patients (p=0.038).</p><p><strong>Conclusion</strong>: This study showed a significant effect of combined VDCS on mean urinary calcium excretion, de novo hypercalciuria, and stone development in VDI patients with history of urolithiasis. Therefore, VDI urolithiasis patients receiving VDCS are advised to have monitoring with 24-hour urine collections and imaging studies. Although small, the sample size is good enough to validate the statistical outcomes. Prospective studies are needed to confirm these results.</p>

scholarly journals Influence of renal function on clinico-pathological features of primary hyperparathyroidism

2003 ◽  
pp. 597-602 ◽  
Author(s):  
H Yamashita ◽  
S Noguchi ◽  
S Uchino ◽  
S Watanabe ◽  
T Murakami ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Primary Hyperparathyroidism ◽  
Normal Renal Function ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Pathological Features ◽  
Function Group ◽  
Renal Function Group

OBJECTIVE: Disturbed renal function may play an important role in the clinico-pathological presentation of primary hyperparathyroidism (pHPT). We studied the influence of renal function on the clinico-pathological characteristics of 141 patients (123 women and 18 men) with surgically proven pHPT. METHODS: The 141 patients were assigned to one of two groups based on creatinine clearance (C(cr)) level: a renal insufficiency group (n=37) in which C(cr) of patients was <70 ml/min and a normal renal function group (n=104) in which C(cr) was > or =70 ml/min. Clinical presentation and biochemical indices were evaluated and compared between the two groups. RESULTS: Age, and frequency of hypertension and of diabetes mellitus were significantly (P<0.001, P<0.05 and P<0.05 respectively) higher in the renal insufficiency group than in the normal renal function group. Serum levels of calcium, intact parathyroid hormone and bone Gla protein were significantly (P<0.05) higher and the excised parathyroid weighed significantly more (P<0.05) in the renal insufficiency group than in the normal renal function group; however, serum 1,25-dihydroxyvitamin D (1,25(OH)(2)D) and 24 h urinary calcium excretion were significantly (P<0.001 and P<0.05 respectively) lower in the former than in the latter group. There was a significant inverse correlation between C(cr) level and serum calcium (r=0.315, P<0.001) and a significant positive correlation between C(cr) level, 1,25(OH)(2)D (r=0.315, P<0.001), and 24 h calcium excretion (r=0.458, P<0.0001). CONCLUSIONS: Clinico-pathological features of pHPT were notably influenced by even moderate renal insufficiency. Urinary calcium excretion decreased according to the decrease in glomerular filtration rate. Therefore, endocrinologists need to appraise urinary calcium excretion and renal function of pHPT patients when considering surgery or in discriminating familial hypocalciuric hypercalcemia.

scholarly journals Vitamin D Repletion in Patients with Primary Hyperparathyroidism and Coexistent Vitamin D Insufficiency

2005 ◽  
Vol 90 (4) ◽  
pp. 2122-2126 ◽  
Author(s):  
Andrew Grey ◽  
Jenny Lucas ◽  
Anne Horne ◽  
Greg Gamble ◽  
James S. Davidson ◽  
...  
Keyword(s):  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Serum Alkaline Phosphatase ◽  
Vitamin D Insufficiency ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Total Serum ◽  
Calcium Excretion ◽  
Intact Pth

Abstract Vitamin D insufficiency is common in patients with primary hyperparathyroidism (PHPT) and may be associated with more severe and progressive disease. Uncertainty exists, however, as to whether repletion of vitamin D should be undertaken in patients with PHPT. Here we report the effects of vitamin D repletion on biochemical outcomes over 1 yr in a group of 21 patients with mild PHPT [serum calcium &lt;12 mg/dl (3 mmol/liter)] and coexistent vitamin D insufficiency [serum 25 hydroxyvitamin D [25(OH)D] &lt;20 μg/liter (50 nmol/liter)]. In response to vitamin D repletion to a serum 25(OH)D level greater than 20 μg/liter (50 nmol/liter), mean levels of serum calcium and phosphate did not change, and serum calcium did not exceed 12 mg/dl (3 mmol/liter) in any patient. Levels of intact PTH fell by 24% at 6 months (P &lt; 0.01) and 26% at 12 months (P &lt; 0.01). There was an inverse relationship between the change in serum 25(OH)D and that in intact PTH (r = −0.43, P = 0.056). At 12 months, total serum alkaline phosphatase was significantly lower, and urine N-telopeptides tended to be lower than baseline values (P = 0.02 and 0.13, respectively). In two patients, 24-h urinary calcium excretion rose to exceed 400 mg/d, but the group mean 24-h urinary calcium excretion did not change. These preliminary data suggest that vitamin D repletion in patients with PHPT does not exacerbate hypercalcemia and may decrease levels of PTH and bone turnover. Some patients with PHPT may experience an increase in urinary calcium excretion after vitamin D repletion.

Familial hypocalciuric hypercalcaemia: observations on vitamin D metabolism and parathyroid function

1983 ◽  
Vol 104 (2) ◽  
pp. 210-215 ◽  
Author(s):  
M. Davies ◽  
P. H. Adams ◽  
J. L. Berry ◽  
G. A. Lumb ◽  
P. S. Klimiuk ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Concentration ◽  
Primary Hyperparathyroidism ◽  
Calcium Excretion ◽  
Renal Tubules ◽  
Vitamin D Metabolites ◽  
Vitamin D Metabolism ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D ◽  
Renal Tubular

Abstract. Serum vitamin D metabolites, the renal tubular maximum reabsorptive rate for phosphate (TMP/GFR) nephrogenic cyclic AMP (NcAMPI, and CaE (urinary calcium excretion per litre of glomerular filtrate) were measured in 14 adults with familial hypocalciuric hypercalcaemia (FHH). The findings were compared with analyses in 14 patients with surgically proven primary hyperparathyroidism matched for serum calcium, creatinine clearance and vitamin D status (assessed by serum concentrations of 25 hydroxyvitamin D). Vitamin D metabolites were also measured in 16 normocalcaemic relatives of patients with FHH. The serum concentration of 24, 25 dihydroxycholecalciferol was appropriate for the prevailing 25 hydroxyvitamin D and no difference was found between groups. The serum concentration of 1, 25 dihydroxycholecalciferol was significantly greater in primary hyperparathyroidism (P < 0.0005) compared with patients with FHH and their normocalcaemic relatives. TMP/GFR was reduced in both primary hyperparathyroidism (0.53 ± 0.12 mmol/l GF, mean ± sem) and FHH (0.86 ±0.14 mmol/l GF). Patients with primary hyperparathyroidism showed an increase in NcAMP output in the urine (38.5 ± 16 mmol/l GF) which was significantly greater (P < 0.0001) than the normal NcAMP (13.5 ± 9.2 nmol/l GF) found in FHH. CaE was low in FHH indicating increased renal tubular reabsorption of calcium. It is concluded that there is no abnormality of vitamin D metabolism in FHH comparable with the changes observed in primary hyperparathyroidism. It is suggested that the biochemical abnormalities in FHH cannot be explained solely upon an increased sensitivity of the renal tubules to the effects of endogenous parathyroid hormone.

Factors influencing pre-operative urinary calcium excretion in primary hyperparathyroidism

2017 ◽  
Vol 87 (1) ◽  
pp. 97-102 ◽  
Author(s):  
Reto M. Kaderli ◽  
Philipp Riss ◽  
Angelika Geroldinger ◽  
Andreas Selberherr ◽  
Christian Scheuba ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Factors Influencing

Comparison of different measures of urinary calcium excretion in primary hyperparathyroidism

2013 ◽  
pp. 1-1
Author(s):  
Christopher Smith ◽  
Andrew Gallagher ◽  
Stephen Gallacher ◽  
Fergus MacLean ◽  
Paul Johnson ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion

scholarly journals High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism

2019 ◽  
Vol 44 (5) ◽  
pp. 1189-1195 ◽  
Author(s):  
Alyne Layane Pereira Lemos ◽  
Sergio Ricardo de Lima Andrade ◽  
Lívia Laeny Henrique Pontes ◽  
Patricia Moura Cravo Teixeira ◽  
Elba Bandeira ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Kidney Stones ◽  
Urinary Calcium ◽  
Normal Serum ◽  
Urinary Calcium Excretion ◽  
High Rate ◽  
Calcium Excretion ◽  
History Of ◽  
Serum Pth

Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT.

Hypercalcaemia of Malignancy: Evidence for a Non-Parathyroid Humoral Agent with An Effect on Renal Tubular Handling of Calcium

1984 ◽  
Vol 66 (2) ◽  
pp. 187-191 ◽  
Author(s):  
S. H. Ralston ◽  
I. Fogelman ◽  
M. D. Gardner ◽  
F. J. Dryburgh ◽  
R. A. Cowan ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Renal Handling ◽  
Calcium Reabsorption ◽  
Humoral Agent ◽  
Calcium Infusion ◽  
Calcium Load ◽  
Renal Tubular

1. The renal handling of calcium was examined in 31 patients with hypercalcaemia of malignancy. Results were compared with those from patients with primary hyperparathyroidism, and normal controls rendered hypercalcaemic by calcium infusion. 2. On relating the urinary calcium excretion indices to serum calcium values, inappropriately low rates of urinary calcium excretion were generally found in patients with malignancy associated hypercalcaemia. Further, the pattern of urinary calcium excretion in these subjects was similar to that found in patients with primary hyperparathyroidism. 3. These observations suggest that, in many solid tumours, the development of hypercalcaemia may be attributable to a humoral mediator with a parathyroid hormone-like effect on renal tubular calcium reabsorption. 4. The relatively frequent occurrence of hypercalcaemia in malignant disease thus may be partially explained by the presence of this humoral agent, which may impair the renal excretion of an increase in filtered calcium load, whether due to bone metastases, or humorally mediated osteolysis.

scholarly journals The Importance of Interpreting Urine Calcium:Creatinine Ratio in PHPT Within Ethnic Context

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A226-A227
Author(s):  
Mariana Abdel-Malek ◽  
Shamaila Zaman ◽  
George Tharakan ◽  
Edouard G Mills ◽  
Adam John Buckley ◽  
...  
Keyword(s):  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Age Groups ◽  
Underlying Mechanism ◽  
Organ Damage ◽  
Urinary Calcium ◽  
Renal Ultrasound ◽  
Calcium Excretion ◽  
Hydroxyvitamin D ◽  
Definitive Evidence

Abstract A 56-year-old Afro-Caribbean lady was found to have incidental hypercalcaemia on routine GP investigations. Tiredness was the only elicitable hypercalcaemic symptom and aside from early menopause at age 40, she had no significant past medical or family history. Examination was unremarkable. Blood results showed a raised adjusted calcium 2.68mmol/L (2.2–2.6), normal phosphate 1.06mmol/L (0.80–1.50), raised parathyroid hormone (PTH) 14.1pmol/L (1.6–7.2) and low 25-hydroxyvitamin D 28.1nmol/L (70–150). She had osteopaenia of the femora and left radius on DEXA scan but no nephrocalcinosis on renal ultrasound. On initial investigation, her urinary calcium output was low at 1.55mmol/day resulting in a 24h calcium:creatinine ratio (UCCR) of 0.0065. Although suggestive of Familial Hypocalciuric Hypercalcaemia (FHH), her notable Vitamin D deficiency was considered to contribute to the observed hypocalciuria. After Vitamin D repletion, a repeat UCCR improved to 0.012, however, remained in the indeterminate range. No known pathogenic variant was identified on genetic analysis for FHH. Her PTH and Calcium levels remained persistently high within 9.7–17.1pmol/L and 2.65-2.82mmol/L respectively, suggestive of Primary Hyperparathyroidism (PHPT) given the end organ damage and negative genetic studies. Based on her symptom of fatigue, osteopaenia at a young age and hypercalcaemia, localisation studies were arranged which showed no definitive evidence of a parathyroid adenoma and explorative surgery was planned. The negative genetic testing, PTH level 17.1pmol/L, osteopaenia, low-normal magnesium and phosphate level collectively support a diagnosis of PHPT in this case, despite a low UCCR which however is observed in some PHPT patients. Indeed, a lower UCCR ratio has been reported in the healthy Afro-Carribean population across all age groups, as well as in Afro-Carribean patients with PHPT [1]. The underlying mechanism for this is yet to be determined but may be due to increased renal sensitivity to PTH or altered activity of the tubular calcium reabsorptive pathways. One can further speculate regarding an evolutionary reason behind a protective homeostatic system favouring renal calcium reabsorption over excretion in this frequently vitamin D deficient population. Clinical practice relies heavily on the use of UCCR in aiding the biochemical differentiation of PHPT and FHH. However, as this case highlights, its use can be misleading in Afro-Carribean patients and therefore should be interpreted within an ethnic context. References: Taha W., Singh N., Flack J. M., Abou-Samra A. B. Low urine calcium excretion in African American patients with Primary Hyperparathyroidism. Endocr Pract. 2011; 17: 867–872

scholarly journals Effects of Above Average Summer Sun Exposure on Serum 25-Hydroxyvitamin D and Calcium Absorption

2002 ◽  
Vol 87 (11) ◽  
pp. 4952-4956 ◽  
Author(s):  
M. Janet Barger-Lux ◽  
Robert P. Heaney
Keyword(s):  
Calcium Absorption ◽  
Sun Exposure ◽  
Urinary Calcium ◽  
Seasonal Difference ◽  
Interquartile Range ◽  
Late Winter ◽  
Calcium Excretion ◽  
Creatinine Ratio ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Abstract The purpose of this study was to examine the effects of summer sun exposure on serum 25-hydroxyvitamin D [25(OH)D], calcium absorption fraction, and urinary calcium excretion. Subjects were 30 healthy men who had just completed a summer season of extended outdoor activity (e.g. landscaping, construction work, farming, or recreation). Twenty-six subjects completed both visits: after summer sun exposure and again approximately 175 d later, after winter sun deprivation. We characterized each subject’s sun exposure by locale, schedule, and usual attire. At both visits we measured serum 25(OH)D, fasting urinary calcium to creatinine ratio, and calcium absorption fraction. Median serum 25(OH)D decreased from 122 nmol/liter in late summer to 74 nmol/liter in late winter. The median seasonal difference of 49 nmol/liter (interquartile range, 29–67) was highly significant (P &lt; 0.0001). However, we found only a trivial, nonsignificant seasonal difference in calcium absorption fraction and no change in fasting urinary calcium to creatinine ratio. Findings from earlier work indicate that our subjects’ sun exposure was equivalent in 25(OH)D production to extended oral dosing with 70 μg/d vitamin D3 (interquartile range, 41–96) or, equivalently, 2800 IU/d (interquartile range, 1640–3840). Despite this input, at the late winter visit, 25(OH)D was less than 50 nmol/liter in 3 subjects and less than 75 nmol/liter in 15 subjects.

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