The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Karaseva E.V.

National Medical Research Center of Endocrinology

Eremkina A.K.

National Medical Research Center for Endocrinology

Elfimova A.R.

National Medical Research Center of Endocrinology

Bibik E.E.

National Medical Research Center for Endocrinology

Gorbacheva A.M.

National Medical Research Center for Endocrinology

Kovaleva E.V.

Endocrinology Research Centre

Mokrysheva N.G.

National Medical Research Center for Endocrinology

The short test with active metabolites of vitamin D in differential diagnosis between primary normocalcemic and secondary hyperparathyroidism for inpatient treatment

Authors:

Karaseva E.V., Eremkina A.K., Elfimova A.R., Bibik E.E., Gorbacheva A.M., Kovaleva E.V., Mokrysheva N.G.

More about the authors

Journal: Russian Journal of Preventive Medicine. 2022;25(6): 68‑74

DOI: 10.17116/profmed20222506168

Views: 3035

Downloaded: 154

Download PDF (RU)
Contact the author
Table of contents

To cite this article:

Karaseva EV, Eremkina AK, Elfimova AR, Bibik EE, Gorbacheva AM, Kovaleva EV, Mokrysheva NG. The short test with active metabolites of vitamin D in differential diagnosis between primary normocalcemic and secondary hyperparathyroidism for inpatient treatment. Russian Journal of Preventive Medicine. 2022;25(6):68‑74. (In Russ.)
https://doi.org/10.17116/profmed20222506168

 
МСФ на ЯМ
Close metadata

Normocalcemic primary hyperparathyroidism (nPHPT) is a phenotype of PHPT characterized by normal serum calcium and persistently increased parathyroid hormone (PTH) after exclusion of secondary causes of PTH elevation (SHPT). Functional diagnostic tests, including test with active vitamin D, could be useful in differential diagnosis between nPHPT and SHPT.

PURPOSE OF THE STUDY

The aim of this study was to investigate the capability of short test with active metabolites of vitamin D for differential diagnosis between nPHPT and SHPT for inpatient treatment.

MATERIAL AND METHODS

We included 90 hospitalized patients with normal albumin-adjusted calcium (Caadj) and elevated PTH levels (84 women, 6 men, median age 60 years). Caadj, PTH, creatinine, eGFR, daily calciuria were evaluated before and PTH, Caadj 3—5 days after taking 1 mcg of alfacalcidol or calcitriol.

RESULTS

According to baseline and dynamic biochemical evaluation patients were divided into 3 groups: group 1 — patients with elevated (n=28) or within the upper limit PTH (n=4) who reached hypercalcemia (Caadj>2.55 mmol/l); group 2 (n=14) — patients with normalization of PTH and normal Caadj; group 3 (n=44) patients with elevated PTH and normal Caadj. In group 1, baseline Caadj. was 2.52 mmol/l (2.50; 2.54), PTH 101.1 pg/ml (81.9; 138.0), after short test — 2.61mmol/l (2.58; 2.64), and 92.2 pg/ml (71.2; 119.5) respectively, regarded as PHPT. Among them 19 patients underwent surgery with histological confirmation of diagnosis. 2 patients are waiting for surgery, 11 patients with asymptomatic form are under dynamic observation. In group 2, baseline Caadj was 2.33 mmol/l (2.31; 2.44), PTH 81.1 pg/ml (72.9; 95.7) vs 2.40 mmol/l (2.33; 2.51) and 54.53 pg/ml (40.7; 63.6) respectively after short test regarded as SHPT. Groups with PHPT and SHPT significantly differed from each other in Caadj and daily calciuria (p<0.05) but not in PTH, eGFR. 44 patients from group 3 did not show significant changes thus differential diagnosis was continued on an outpatient basis.

CONCLUSION

The study showed the significant changes in calcium and PTH levels during the short test in 46/90 patients. Stable normocalcemia and normalization of PTH allows confirming SHPT while elevated or within the upper limit of PTH levels with hypercalcemia — PHPT.

Keywords:

hyperparathyroidism
parathyroid hormone
vitamin D
alfacalcidol
calcitriol

Authors:

Karaseva E.V.

National Medical Research Center of Endocrinology

Eremkina A.K.

National Medical Research Center for Endocrinology

Elfimova A.R.

National Medical Research Center of Endocrinology

Bibik E.E.

National Medical Research Center for Endocrinology

Gorbacheva A.M.

National Medical Research Center for Endocrinology

Kovaleva E.V.

Endocrinology Research Centre

Mokrysheva N.G.

National Medical Research Center for Endocrinology

Received:

07.03.2022

Accepted:

12.04.2022

List of references:

  1. Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism. Arquivos Brasileiros de Endocrinologia e Metabologia. 2010;54(2):106-109.  https://doi.org/10.1590/s0004-27302010000200004
  2. Schini M, Jacques RM, Oakes E, Peel NFA, Walsh JS, Eastell R. Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History. The Journal of Clinical Endocrinology and Metabolism. 2020;105(4):1171-1186. https://doi.org/10.1210/clinem/dgaa084
  3. Maeda SS, Saraiva GL, Kunii IS, Hayashi LF, Cendoroglo MS, Ramos LR, Lazaretti-Castro M. Factors affecting vitamin D status in different populations in the city of São Paulo, Brazil: the São PAulo vitamin D Evaluation Study (SPADES). BMC Endocrine Disorders. 2013;13:14.  https://doi.org/10.1186/1472-6823-13-14
  4. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. The Journal of Clinical Endocrinology and Metabolism. 2011; 96(1):53-58.  https://doi.org/10.1210/jc.2010-2704
  5. Martinez I, Saracho R, Montenegro J, Llach F. The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure. American Journal of Kidney Diseases. 1997;29(4):496-502.  https://doi.org/10.1016/s0272-6386(97)90330-9
  6. Walker MD, Dempster DW, McMahon DJ, Udesky J, Shane E, Bilezikian JP, Silverberg SJ. Effect of renal function on skeletal health in primary hyperparathyroidism. The Journal of Clinical Endocrinology and Metabolism. 2012;97(5):1501-1507. https://doi.org/10.1210/jc.2011-3072
  7. Rejnmark L, Vestergaard P, Heickendorff L, Andreasen F, Mosekilde L. Effects of thiazide- and loop-diuretics, alone or in combination, on calcitropic hormones and biochemical bone markers: a randomized controlled study. Journal of Internal Medicine. 2001;250(2):144-153.  https://doi.org/10.1046/j.1365-2796.2001.00868.x
  8. Mallette LE, Khouri K, Zengotita H, Hollis BW, Malini S. Lithium treatment increases intact and midregion parathyroid hormone and parathyroid volume. The Journal of Clinical Endocrinology and Metabolism. 1989;68(3): 654-660.  https://doi.org/10.1210/jcem-68-3-654
  9. Makras P, Polyzos SA, Papatheodorou A, Kokkoris P, Chatzifotiadis D, Anastasilakis AD. Parathyroid hormone changes following denosumab treatment in postmenopausal osteoporosis. Clinical Endocrinology. 2013;79(4): 499-503.  https://doi.org/10.1111/cen.12188
  10. Fraser WD, Logue FC, Gallacher SJ, O’Reilly DS, Beastall GH, Ralston SH, Boyle IT. Direct and indirect assessment of the parathyroid hormone response to pamidronate therapy in Paget’s disease of bone and hypercalcaemia of malignancy. Bone and Mineral. 1991;12(2):113-121.  https://doi.org/10.1016/0169-6009(91)90040-7
  11. Coe FL, Canterbury JM, Firpo JJ, Reiss E. Evidence for secondary hyperparathyroidism in idiopathic hypercalciuria. The Journal of Clinical Investigation. 1973;52(1):134-142.  https://doi.org/10.1172/JCI107156
  12. Balsa JA, Botella-Carretero JI, Peromingo R, Zamarrón I, Arrieta F, Muñoz-Malo T, Vázquez C. Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. Journal of Endocrinological Investigation. 2008;31(10):845-850.  https://doi.org/10.1007/BF03346429
  13. Selby PL, Davies M, Adams JE, Mawer EB. Bone loss in celiac disease is related to secondary hyperparathyroidism. Journal of Bone and Mineral Research. 1999;14(4):652-657.  https://doi.org/10.1359/jbmr.1999.14.4.652
  14. Mokrysheva NG, Eremkina AK, Mirnaya SS, Kovaleva EV. Challenges in differential diagnosis between primary and secondary forms of hyperparathyroidism. Ozhirenie i metabolizm. 2017;14(3):48-53. (In Russ.). https://doi.org/10.14341/omet2017348-53
  15. Mokrysheva NG, Eremkina AK, Mirnaya SS, Krupinova JA, Voronkova IA, Kim IV, Beltsevich DG, Kuznetzov NS, Pigarova EA, Rozhinskaya LYa, Degtyarev MV, Egshatyan LV, Rumiantsev PO, Andreeva EN, Antsiferov MB, Markina NV, Kryukova IV, Karonova TL, Lukyanov SV, Sleptsov IV, Chagay NB, Melnichenko GA, Dedov II. The clinical practice guidelines for primary hyperparathyroidism, short version. Problemy endokrinologii. 2021; 67(4):94-124. (In Russ.). https://doi.org/10.14341/probl12801
  16. Boudou P, Ibrahim F, Cormier C, Sarfati E, Souberbielle JC. A very high incidence of low 25 hydroxy-vitamin D serum concentration in a French population of patients with primary hyperparathyroidism. Journal of Endocrinological Investigation. 2006;29(6):511-515.  https://doi.org/10.1007/BF03344140
  17. Silverberg SJ, Walker MD, Bilezikian JP. Asymptomatic primary hyperparathyroidism. Journal of Clinical Densitometry. 2013;16(1):14-21.  https://doi.org/10.1016/j.jocd.2012.11.005
  18. Moosgaard B, Vestergaard P, Heickendorff L, Melsen F, Christiansen P, Mosekilde L. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clinical Endocrinology. 2005;63(5):506-513.  https://doi.org/10.1111/j.1365-2265.2005.02371.x
  19. Maganeva IS, Pigarova EA, Shulpekova NV, Dzeranova LK, Eremkina AK, Milyutina AP, Povalyaeva AA, Zhukov AYu, Bogdanov VP, Rozhinskaya LYa, Mokrysheva NG. Vitamin D metabolite and calcium phosphorus metabolism in in patients with primary hyperparathyroidism on the background of bolus therapy with colecalciferol. Problemy endokrinologii. 2021;67(6):68-79. (In Russ.). https://doi.org/10.14341/probl12851
  20. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2011;96(7):1911-1930. https://doi.org/10.1210/jc.2011-0385
  21. Hagag P, Revet-Zak I, Hod N, Horne T, Rapoport MJ, Weiss M. Diagnosis of normocalcemic hyperparathyroidism by oral calcium loading test. Journal of Endocrinological Investigation. 2003;26(4):327-332.  https://doi.org/10.1007/BF03345180
  22. Zhu X, Shan C, Zhu Q, Song L, Zhou Y, Liu J, Zhang K. Clinical value of calcium load test in differential diagnosis of different types of hyperparathyroidism. International Journal of Clinical and Experimental Medicine. 2014; 7(12):5445-5452.
  23. Guo Y, Wang Q, Lu C, Fan P, Li J, Luo X, Chen D. New parathyroid function index for the differentiation of primary and secondary hyperparathyroidism: a case-control study. BMC Endocrine Disorders. 2020;20(1):5.  https://doi.org/10.1186/s12902-019-0487-8
  24. Souberbielle JC, Cavalier E, Cormier C. How to manage an isolated elevated PTH? Annales D’endocrinologie. 2015;76(2):134-141.  https://doi.org/10.1016/j.ando.2015.03.005
  25. Rajkumar V, Levine SN. Normocalcemic Hyperparathyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; January 28, 2022.
  26. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress DL. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney International. 2007;71(1):31-38.  https://doi.org/10.1038/sj.ki.5002009
  27. Pamputis SN, Lopatnikova EN. Differential diagnosis of normocalcemic primary hyperparathyroidism using the diagnostic test «test with alfacalcidol». Tavricheskij mediko-biologicheskij vestnik. 2017;20(3-2):205-211. (In Russ.).

Close metadata

Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.