Serum vitamin D metabolite concentrations in primary hyperparathyroidism.

Forty-nine patients with primary hyperparathyroidism were examined preoperatively and three months after parathyroid operation for their serum vitamin D metabolites and routine laboratory samples related to calcium metabolism. The preoperative serum 24,25-dihydroxyvitamin D level, mean (SE) was 1.86 (0.22) nmol/l and the postoperative level 5.35 (0.63) nmol/l, the difference being highly significant (P less than 0.001). Serum 1,25-dihydroxyvitamin D levels fell significantly (P less than 0.001) from a preoperative level of 175.5 (17.9) pmol/l to 102.8 (10.1) pmol/l postoperatively. The preoperative 25-hydroxyvitamin D level did not change significantly after surgery. The preoperative serum 24,25-dihydroxyvitamin D level was very low, especially in patients with bone disease while serum parathormone was significantly higher than in patients without bone disease.

Clinical and biochemical features in primary hyperparathyroidism.

Sixty-one consecutive patients were examined to determine the current mode of presentation of primary hyperparathyroidism (pHPT). Of these patients, 37.7% were asymptomatic, and the initial indication of pHPT was hypercalcemia, which was found unexpectedly on biochemical screening of the serum in elderly patients. Hypertension was twice as common among patients with pHPT as in the general population (36.1%). The next most common presentations were urinary calculi (18%) and mental depression (18%). The most useful discriminant laboratory tests were serum calcium, phosphorus, chloride, and parathormone (PTH). The calculated coefficient of correlation of PTH to land weight was high (r = 0.571, p less than 0.001). There was very significant correlation between PTH and seriousness of bone disease (r = 0.620, p less than 0.001). After parathyroidectomy, 3.3% of patients remained hypercalcemic, 93% were normocalcemic, and 1.6% were hypocalcemic.