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Emad Kandil, MD; Anthony P. Tufaro, MD, DDS; Kathryn A. Carson, ScM; Frank Lin, MD; Helina Somervell, CRNP; Tarik Farrag, MD; Alan Dackiw, MD; Martha Zeiger, MD; Ralph P. Tufano, MD

Arch Otolaryngol Head Neck Surg. 2008;134(10):1071-1075.

Objectives  To determine the relationship between preoperative plasma 25-hydroxyvitamin D (25[OH]D) levels and severity of primary hyperparathyroidism (PHPT) and to explore whether presurgical 25(OH)D levels could predict the likelihood of positive results on technetium Tc 99m sestamibi scintigraphy.

Design  Retrospective analysis.

Setting  Tertiary university referral center.

Patients  A total of 421 consecutive patients underwent preoperative sestamibi scintigraphy and parathyroid exploration. Patients with cholecalciferol (vitamin D) deficiency, defined as plasma levels lower than 25 ng/mL, were compared with patients having no vitamin D deficiency. We explored the relationship between 25 (OH)D levels and intact parathyroid hormone (iPTH) levels, alkaline phosphatase (ALKP) levels, adenoma weight, binary sestamibi scan results, and postoperative serum calcium levels (at 1 week and 6 months).

Main Outcome Measures  We hypothesized that severity of hypovitaminosis D would correlate with severity of PHPT and predict the likelihood of a positive finding on sestamibi scan.

Results  Concentrations of iPTH and ALKP and parathyroid adenoma weight were significantly higher in patients with lower 25(OH)D levels (P < .01 for all). Patients with hypovitaminosis D had a greater percentage decrease in serum calcium levels 1 week and 6 months postoperatively (P < .05). Median 25(OH)D levels were lower in patients with positive sestamibi scan results (P < .001).

Conclusions  Patients with hypovitaminosis D present with more advanced indices of PHPT. Parathyroid sestamibi scanning is more likely to show positive results for this subset of patients who may then benefit from sestamibi scan–directed surgical intervention.

Author Affiliations: Division of Endocrine and Oncological Surgery (Drs Kandil, Tufaro, Dackiw, and Zeiger and Ms Somervell), Department of Otolaryngology–Head and Neck Surgery (Drs Lin, Farrag, and Tufano), Johns Hopkins Medical Institutions, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (Ms Carson), Baltimore, Maryland.

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