Published in:
01-02-2011 | Endocrine Tumors
Letter to the Editor: 25-Hydroxyvitamin D Status does not Affect Intraoperative Parathyroid Hormone Dynamics in Patients with Primary Hyperparathyroidism
Published in: Annals of Surgical Oncology | Issue 2/2011
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We read with interest the article by Joel T. Adler et al.1 and we congratulate them for their productive work. The impact of vitamin D deficiency on the kinetics of parathormone (PTH) secretion and utility of intraoperative PTH (ioPTH) in predicting complete tumor-excision is always been a concern, especially in vitamin-D-deficient areas.2 We agree with authors, that concurrent vitamin D deficiency and primary hyperparathyroidism leads to increased gland weight; however, being from a vitamin-D-deficient endemic area, we observed relatively more severe bone complaints, with significant proportion presenting with brown tumors or fragility fractures, the serum alkaline-phosphatase (ALP) and PTH levels significantly higher, and predominantly female involvement in deficient than sufficient group.3 – 5 Therefore, we would like to know from the authors:
1.
Mean levels of vitamin D in the sufficient and deficient groups and the method for estimation, which may explain the relative absence of bony features and the comparable ALP and PTH levels.
2.
Vitamin D deficiency leads to hyperplasia of all parathyroid glands and, following excision of the prelocalized single-adenomatous gland, if the ioPTH does not meet the criteria of surgical success, is it difficult to find out the next culprit gland, more so, if it was not localized preoperatively, did the authors encounter any such problem, and how did they manage?
3.
In the three patients who did not achieve surgical success, what was vitamin D status?
4.
Postoperatively how many patients experienced hypocalcemia? Did the authors supplement them with vitamin D, because it may affect the PTH and calcium kinetics?