Abstract
Calcium homeostasis is maintained by increase in parathyroid hormone (PTH) secretion in patients with vitamin D deficiency. In several studies it was suggested that not all patients with hypovitaminosis D develop secondary hyperparathyroidism. The aim of this study was to evaluate PTH response in women with low serum 25(OH) vitamin D levels. 58 consecutive patients with a serum 25(OH) vitamin D concentrations <20 ng/ml were included in the study. Serum PTH and calcium levels of the patients were noted. Serum 25(OH) vitamin D concentrations between 12 and 20 ng/ml was defined as ‘D vitamin insufficiency’ and below 12 ng/ml was defined as ‘D vitamin deficiency’. The mean age of the patients was 57.2 ± 15.3 (26-87) years. Among all the patients with a mean serum 25(OH) vitamin D concentrations of 8.8 ± 3.9 ng/mL, 77.6% of them had D vitamin deficiency. The mean of serum intact PTH concentrations was 68.2 ± 29.7 pg/ml. Blood calcium levels of all patients were also within normal ranges. Secondary hyperparathyroidism was detected only in 27 patients, serum PTH levels of the others were normal (<67 pg/ml). There was no statistically significant differences between the mean age, serum PTH and calcium levels of the both groups. Secondary hyperparathyroidism was detected in 7 patients with vitamin D insufficiency (n= 13) and in 20 patients with vitamin D deficiency (n= 45). Secondary hyperparathyroidism was not observed in 53.4% of our patients, this result is consistent with several studies in the relevant literature. Further studies are necessary to investigate the causes of decreased parathyroid hormone responses in these patients who have low serum 25(OH) vitamin D levels .
References
- 1. İkbal Karadavut K, Çakcı A. Türk kadınlarında vitamin D eksikliği. Osteoporoz Dünyasından 2003;9:74-9.
- 2. Gökçe Kutsal Y. Osteomalazi. Eryavuz Sarı-doğan M, editörler. Osteoporoz tanı ve tedavi kılavuzu. 1. baskı. İstanbul: Deomed Medikal Yayıncılık; 2005. p. 157-63.
- 3. Parfitt AM, Podenphant J, Villanueva AR, Frame B. Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: a bone histomorphometric study. Bone 1985;6:211-20.
- 4. Serhan E, Newton P, Ali HA, Walford S, Singh BM. Prevelance of hypovitaminosis D in IndoAsian patients attending a rheumatology clinic. Bone 1999;5:609-11.
- 5. Rao DS. Perspective on assessment of vitamin D nutrition. J Clin Densitom 1999;2:457-64.
- 6. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004; 35:312-9.
- 7. Outila TA, Karkkainen MUM, Lamberg-Allardt CJE. Vitamin D status effects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm mineral density. Am J Clin Nutr 2001;74:206-10. KAYNAKLAR
- 8. Peacock M, Selby PL, Francis RM, Brown WB, Hordon L. Vitamin D deficiency, insufficiency and intoxication. What do they mean. In: Norman AW, Schaefer K, Grigoleit HG, Her-rath DV, eds. Vitamin D. Berlin: Walter de Gruyter;1985. p.569-70.
- 9. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD. Vitamin D and bone health in elderly. Am J Clin Nutr 1982; 36:1014-31.
- 10. Ooms ME, Lips P, Roos JC, van der Vijgh WJF, Poop-Snijders C, Bezemer PD, et al. Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 1995;10:1177-84.
- 11. Thomas MK, Lloyd Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Eng J Med 1998;338:777-83.
- 12. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet 1998; 351:805-6.
- 13. Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson Hughes B. Effect of vitamin D intake on seasonal variations in parathyroid hormone secretionin postmenopausal women. N Eng J Med 1989;321:1777-83.
- 14. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hereberg S, et al. Prevelance of vitamin D insufficiency in an adult normal population. Osteoporosis Int 1997;7: 439-43.
- 15. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D defi-ciecy in postmenopausal US women with acute hip fracture. JAMA 1999;281:1505-11.
- 16. Bettica, Bevillacqua M, Vago T, Norbiato P. High prevalence of hypovitaminosis D among free-living postmenopausal women referred to an osteoporosis outpatient clinic in Northern Italy for initial screening. Osteoporosis Int 1999;9:226-9.
- 17. Aguado P, del Campo MT, Garces MV, Gon-zalez-Casaus ML, Bemad M, Gijon-Banos J, et al. Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density. Osteoporosis Int 2000; 11:739-44.
- 18. Kaya T, Ulutaş Ö, Çelebiler Çavuşoğlu A, Aslanca D, Karatepe AG,Günaydın R, ve ark. Sağlıklı postmenopozal kadınlarda serum 25(OH)Vitamin D düzeyi ve hiperparatiroidi. Romatizma 2007;22:20-3.
- 19. Zajac JD. Regulation of parathyroid function. Bone 2000;27:7S.
- 20. Connolly TM, Bross TE, Majerus PW. Isolation of a phosphomonesterase from human platelets that specifically hydrolyses 5-phosphate. J Biol Chern 1985;260:7868-74.
Abstract
D vitamini eksikliği olan hastalarda kanda paratiroid hormon (PTH) salınımının artışı ile kalsiyum homeostazı sağlanmaktadır. Yapılan bazı çalışmalarda D vitamini eksikliği olan tüm hastalarda sekonder hiperparatiroidizmin gelişmediği öne sürülmüştür. Bu çalışmanın amacı serum 25(OH) vitamin D düzeyi düşük olan kadınlarda PTH yanıtını değerlendirmektir. Serum 25(OH) vitamin D konsantrasyonu 20 ng/ml’nin altında olan 58 ardışık hasta çalışmaya dahil edildi. Hasta -ların serum PTH ve kalsiyum değerleri de kaydedildi. 25(OH) vitamin D konsantrasyonunun 12 ile 20 ng/ml arasında olması ‘D vitamini yetersizliği’, 12 ng/mL altında olması ise ‘D vitamini eksikliği’ olarak tanımlandı. Hastaların yaş ortalaması 57.2 ± 15.3 (26-87) yıldı. Serum 25(OH) vitamin D düzeyleri 8.8 ± 3.9 ng/ml olarak tespit edilen hastaların %77.6’sında D vitamini eksikliği mevcuttu. Ortalama serum intakt PTH konsantrasyonu 68.2 ± 29.7 pg/ml idi. Sadece 27 hastada sekonder hiperparatiroidizm gelişmişti, geriye kalan hastaların serum PTH düzeyleri normaldi (< 67 pg/ml). Tüm hastaların kan kalsiyum seviyeleri de normal sınırlar içerisindeydi. Her iki grubun yaşları, serum PTH ve kalsiyum seviyeleri arasında istatistiksel olarak anlamlı bir farklılık yoktu. Sekonder hiperparatiroidizm, D vitamini yetersizliği saptanan hastaların (n= 13) 7’sinde, D vitamini eksikliği olanların (n= 45) ise 20’sinde gözlendi. Hastaların %53.4’ünde sekonder hiperparatiroidizmin gözlenmemiş olması, bu konuyla ilgili literatürdeki bazı çalışmalarla uyumludur. Serum 25(OH) vitamin D düzeyleri düşük olarak saptanan bu hastalarda azalmış PTH yanıtının nedenlerini araştıracak yeni çalışmalara ihtiyaç duyulmaktadır.
References
- 1. İkbal Karadavut K, Çakcı A. Türk kadınlarında vitamin D eksikliği. Osteoporoz Dünyasından 2003;9:74-9.
- 2. Gökçe Kutsal Y. Osteomalazi. Eryavuz Sarı-doğan M, editörler. Osteoporoz tanı ve tedavi kılavuzu. 1. baskı. İstanbul: Deomed Medikal Yayıncılık; 2005. p. 157-63.
- 3. Parfitt AM, Podenphant J, Villanueva AR, Frame B. Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: a bone histomorphometric study. Bone 1985;6:211-20.
- 4. Serhan E, Newton P, Ali HA, Walford S, Singh BM. Prevelance of hypovitaminosis D in IndoAsian patients attending a rheumatology clinic. Bone 1999;5:609-11.
- 5. Rao DS. Perspective on assessment of vitamin D nutrition. J Clin Densitom 1999;2:457-64.
- 6. Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004; 35:312-9.
- 7. Outila TA, Karkkainen MUM, Lamberg-Allardt CJE. Vitamin D status effects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm mineral density. Am J Clin Nutr 2001;74:206-10. KAYNAKLAR
- 8. Peacock M, Selby PL, Francis RM, Brown WB, Hordon L. Vitamin D deficiency, insufficiency and intoxication. What do they mean. In: Norman AW, Schaefer K, Grigoleit HG, Her-rath DV, eds. Vitamin D. Berlin: Walter de Gruyter;1985. p.569-70.
- 9. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD. Vitamin D and bone health in elderly. Am J Clin Nutr 1982; 36:1014-31.
- 10. Ooms ME, Lips P, Roos JC, van der Vijgh WJF, Poop-Snijders C, Bezemer PD, et al. Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral density in elderly women. J Bone Miner Res 1995;10:1177-84.
- 11. Thomas MK, Lloyd Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Eng J Med 1998;338:777-83.
- 12. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet 1998; 351:805-6.
- 13. Krall EA, Sahyoun N, Tannenbaum S, Dallal GE, Dawson Hughes B. Effect of vitamin D intake on seasonal variations in parathyroid hormone secretionin postmenopausal women. N Eng J Med 1989;321:1777-83.
- 14. Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hereberg S, et al. Prevelance of vitamin D insufficiency in an adult normal population. Osteoporosis Int 1997;7: 439-43.
- 15. LeBoff MS, Kohlmeier L, Hurwitz S, Franklin J, Wright J, Glowacki J. Occult vitamin D defi-ciecy in postmenopausal US women with acute hip fracture. JAMA 1999;281:1505-11.
- 16. Bettica, Bevillacqua M, Vago T, Norbiato P. High prevalence of hypovitaminosis D among free-living postmenopausal women referred to an osteoporosis outpatient clinic in Northern Italy for initial screening. Osteoporosis Int 1999;9:226-9.
- 17. Aguado P, del Campo MT, Garces MV, Gon-zalez-Casaus ML, Bemad M, Gijon-Banos J, et al. Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density. Osteoporosis Int 2000; 11:739-44.
- 18. Kaya T, Ulutaş Ö, Çelebiler Çavuşoğlu A, Aslanca D, Karatepe AG,Günaydın R, ve ark. Sağlıklı postmenopozal kadınlarda serum 25(OH)Vitamin D düzeyi ve hiperparatiroidi. Romatizma 2007;22:20-3.
- 19. Zajac JD. Regulation of parathyroid function. Bone 2000;27:7S.
- 20. Connolly TM, Bross TE, Majerus PW. Isolation of a phosphomonesterase from human platelets that specifically hydrolyses 5-phosphate. J Biol Chern 1985;260:7868-74.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Article |
| Authors | |
| Publication Date | November 20, 2008 |
| Published in Issue | Year 2008 Volume: 2 Issue: 3 |
