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Master Thesis

Statut en vitamine D et conséquences dans l’hyperparathyroïdie primaire en Guadeloupe

Abstract : INTRODUCTION: Vitamin D (VD) insuffisiency seems common in primary hyperparathyroidism (HPP) and appears to worsen clinical and laboratory profiles of PPH. In Guadeloupe despite the continuous sunshine throughout the year, VD insufficiency concern more than half of the population. Currently there are no data on the assessment of VD status in patients with HPP in Guadeloupe. Objectives of this study were to assess the prevalence of VD insufficiency and deficiency in HPP in Guadeloupe, to analyze the impact of VD status on HPP before and after surgery and to assess the effects of VD substitution prior to surgery in this population. METHODS: We conducted a retrospective, descriptive study of patients with HPP monitored in Pointe à Pitre University Hospital between 2009 and 2014. Demographic, clinical and laboratory datas were collected at baseline. In case of surgery serum calcium was collected one month after. PTH and VD levels were collected 6 months after surgery. VD insuffisiency corresponded to a 25(OH)D < 30 ng/mL (group 1), VD deficit to a 25(OH)D <20 ng mL, severe deficiency to a 25(OH)D <10 ng/mL. Subjects sufficient in VD formed group 2. RESULTS: 62 patients with HPP (mean age 62±15.2 years, 74.2% women) were included, 46 had dosing VD available. The average levels of 25(OH)D was 25.8 ± 9.5 ng/ml. The average rate of PTH was 193 ± 112 pg/mL. Mean serum calcium was 2.98 ± 0.4 mmol/L. Prevalence of VD insufficiency was 69.6%, 30.5% for deficiency, 8,8% for severe deficiency. Clinical and biological profiles of subjects in Group 1 and 2 did not differ preoperatively. Among operated patients there was no association between initial status in VD and serum calcium1 month after surgery or between initial VD and postoperative PTH 6 months after surgery. The size of the parathyroid adenoma was not significantly different according to the initial VD status. 75% of patients in group 1 were substituted in VD (group A). 6 months after parathyroidectomy, PTH of patients in group A was lower than that of group 2 patients operated and not substituted in VD (group B) (27 pg/mL vs 40 pg/mL, p=0.04). Postoperative serum calcium levels at 1 month was not higher in group A than in group B. CONCLUSION: Even in a region enjoying of continuously sunshine throughout the year, prevalence of VD insufficiency is high in patients with HPP in Guadeloupe. VD status does not seem to have any impact on the presentation of HPP preoperatively. VD substitution prior to parathyroid surgery improves postoperative decrease in PTH without risk of elevation of serum calcium. The lack of significance of our findings may be related to the small number of patients included, which is why this work should be continued in order to allow in Guadeloupe, thanks to the collaboration between hospital medicine and general medicine, a better management of HPP associated with a VD insuffisiency.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01216617
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Submitted on : Friday, October 16, 2015 - 3:19:30 PM
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Fabien Rolland. Statut en vitamine D et conséquences dans l’hyperparathyroïdie primaire en Guadeloupe. Médecine humaine et pathologie. 2015. ⟨dumas-01216617⟩

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