Seasonal changes in serum calcium,PTH and vitamin D levels in patients with primary hyperparathyroidism |
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| Affiliation: | 1. Soroka University Medical Center, Endocrinology Unit, Beer-Sheva, Israel;2. Soroka University Medical Center, Clinical Research Center, Beer-Sheva, Israel;3. Soroka University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Beer-Sheva, Israel;1. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel;2. The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;3. Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel;1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden;2. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA;3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room: E8527, Baltimore, MD 21205, USA;4. Functional Food and Metabolic Stress Prevention Laboratory, Center of Nutrition, Council for Agricultural Research and Economics, Via Ardeatina 546, 00100 Rome, Italy;5. Department of Surgical Sciences, Section of Orthopedics, Uppsala Clinical Research Center, Akademiska sjukhuset ing. 61 6 tr, 751 85 Uppsala, Sweden;6. Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Edificio U7, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy;7. Clinical Epidemiology Unit, T2, Department of Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden;8. Department of Medicine, Karolinska University Hospital, Huddinge, C2:84, SE-141 86 Stockholm, Sweden;1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States;2. Beck Radiological Innovations, Inc., United States;3. Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, United States;4. Novartis Institute for Biomedical Research, United States;5. Department of Epidemiology and Public Health, University of Maryland, School of Medicine, United States;6. National Institute on Aging, Longitudinal Study Section, United States;7. Department of Sociology and Anthropology, University of Maryland Baltimore County, United States;8. University of Maryland, School of Medicine, United States;9. Research Institute, California Pacific Medical Center, San Francisco, CA, United States;10. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States;11. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, United States;12. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States;13. Laboratory of Epidemiology and Population Sciences Intramural Research Program, National Institute on Aging, United States |
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| Abstract: | BackgroundSeasonal variations of 25-hydroxyvitamin D, PTH and calcium levels are not well characterized in primary hyperparathyroidism (PHPT). Our objectives were to characterize seasonal changes in these parameters in PHPT patients, and to assess whether these seasonal changes affect clinical decision making.MethodsThis is a retrospective study based on the electronic medical records of Clalit Health service in the south of Israel between 2000 and 2012. Patients 18 years and older with PHPT (PTH > upper limit of norm (ULN) and serum calcium > 10.5 mg%) were included. Patients with renal failure or on Thiazide diuretics were excluded. All serum levels of calcium, PTH and 25-hydroxyvitamin D were collected and then stratified according to season.Results792 patients were classified as PHPT (72.2% female) and had a total of 2659 PTH tests, 1395 25-hydroxyvitamin D tests and 7426 calcium test. Fifty six percent of 25-hydroxyvitamin D levels were < 50 nmol/L. Seasonality was demonstrated in all three parameters: mean 25-hydroxyvitamin D was 13% higher in the summer compared to the winter (P < 0.001), median PTH values showed opposite trend with a fall of about 8.4% in summer compared to winter (P < 0.001). Calcium levels were higher during the autumn with a rise of about 0.2 mg/dL in the mean calcium levels compared to spring and summer (P < 0.001). The odds ratio of calcium level above 11.5 mg/dL is highest in the autumn (OR = 1.275, P = 0.018).ConclusionWe show seasonal variation in serum 25-hydroxyvitamin D, PTH, and calcium levels in patients with PHPT. These seasonal variations cause transition to pathological values that may influence diagnosis and treatment of PHPT patients. |
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