| A New, Vitamin D- Based, Multidimensional Nomogram for the Diagnosis of Primary Hyperparathyroidism. | |
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MedLine Citation:
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PMID: 22068245 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objective: The biochemical diagnosis of primary hyperparathyroidism (1○HPT) has traditionally been based on elevated calcium and PTH values. These classic criteria fail to diagnose the subset of patients where calcium, PTH or both lie within the "normal" range. The purpose of this study was to refine diagnostic criteria for 1○HPT to capture these atypical patients.Methods: Total serum calcium, intact PTH, and 25-hydroxy vitamin D levels were measured in 1○HPT and healthy patient groups. Multivariate analysis of healthy patient data first identified factors that significantly impacted PTH levels, and defined a new PTH reference range with a mathematical model. The model was then validated for prediction of atypical 1○HPT in patients with surgically confirmed disease.Results: Calcium (p<0.015), vitamin D (p<0.0001) and age (p<0.0002) independently impacted PTH. With these variables, we created a 4-dimensional nomogram that distinguished normal patients from those with hyperparathyroid states. Mathematically, this nomogram predicts 1○HPT when measured serum PTH is higher than PTH calculated by the formula: PTH (pg/ml) = 120- (6 × calcium (mg/dL))- (0.52 × 25-hydroxy vitamin D (ng/ml)) + (0.26 × patient age (years)). When applied to our surgical group, this nomogram successfully identified 100% (238/238) of patients with classical 1○HPT, 96% (64/67) with normocalcemic 1○HPT and 53% (21/40) with 1○HPT and normal PTH.Conclusion: This study uniquely defines a patient-specific normal limit of PTH based on readily available parameters of calcium, 25-hydroxy vitamin D and age. Our nomogram may allow for more rapid definitive diagnosis and treatment of 1○HPT in patients with atypical presentations. |
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Authors:
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Adrian Harvey; Mengjun Hu; Manjula Gupta; Robert Butler; Jamie Mitchell; Eren Berber; Allan Siperstein; Mira Milas |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-8 |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: - ISSN: 1934-2403 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: - |
Other Details:
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Languages: ENG Pagination: 1-21 Citation Subset: - |
Affiliation:
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Department of Endocrine Surgery, University of Calgary, Calgary, Alberta, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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