Endocrine Abstracts

Primary hyperparathyroidism (1 in 1000) (1) and occult vitamin D deficiency (14% of the healthy adult population) are relatively common disorders (2). Hypercalciuria, renal tract calcification and reduced bone mineral density (BMD) are recognised complications of primary hyperparathyroidism. We report details of the prevalence of vitamin D deficiency and complications in patients with primary hyperparathyroidism.

It is a retrospective study of 44 patients (33 women and 11 men, mean age 65, age range 30–90 years) attending the outpatient clinic for treatment and follow up of primary hyperparathyroidism. Sixty-one percent were Caucasian, 22% Asians and the rest belonged to other ethnic group such as Afro Caribbean. Total vitamin D (D2 and D3) levels were measured in 34 patients. Off these 18% had severe vitamin D deficiency (<5 μg/l) with values as low as 2.4 μg/l. Forty-seven percent had vitamin D deficiency (6–12 μg/l); 18% had vitamin D insufficiency (13–20 μg/l) and 17% had normal vitamin D levels (>20 μg/l).

The 24 h urinary calcium excretion (n=36) was elevated in 36%; normal in 47% and decreased in 17%. Twenty-one percent had renal calculi on ultrasound or CT scan of renal tract (n=38). Seventy-nine percent had no calculi.

BMD was assessed in 29 patients. Mean (±S.D.) spine T scores were −0.89 (±1.86) and femur T scores were −0.53 (±1.36). Thirty-eight percent were classed osteoporotic and 13% were classed osteopenic.

Though vitamin D insufficiency is a common finding in eucalcemic populations it may occur in up to 82% of patients with primary hyperparathyroidism. Up to 18% may have severe deficiency. Furthermore up to 21% may have renal tract calcification. Fifty-one percent patients were either osteoporotic or osteopenic.

We recommend that all patients with primary hyperparathyroidism have their vitamin D status assessed at diagnosis with a view to treat and scan of the renal tract and BMD as standard investigations.