Carla Columbu, Domenico Rendina, Luigi Gennari, Flavia Pugliese, Vincenzo Carnevale, Antonio Stefano Salcuni, Iacopo Chiodini, Claudia Battista, Patrizia Tabacco, Vito Guarnieri, Giuseppe Guglielmi, Cristina Eller-Vainicher, Cristiana Cipriani, Antonello Cuttitta, Gianpaolo De Filippo, Fernanda Velluzzi, Alberto Falchetti, Salvatore Minisola, Afredo Scillitani, Fabio Vescini
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In PHPT patients fibroblast growth factor 23 (FGF23) levels were higher than in controls. Patients with kidney stones carried the 716 T allele more frequently than patients without it (χ<sup>2</sup> 7.20, p = 0.027). In PHPT patients revaluated at least 2 years after surgery, we observed a significant reduction of 1-25(OH)<sub>2</sub>VitaminD and FGF23. According to the median of serum phosphate levels, PHPT patients were subdivided into two subgroups: ≤2.8 mg/dL and > 2.8 mg/dL. The lowest phosphate group had a significantly higher serum calcium, PTH, 1-25(OH)<sub>2</sub>VitaminD, urinary calcium and a higher prevalence of kidney stones than in the highest phosphate group. The rate of males in the lowest phosphate group was significantly higher than in the highest phosphate group.</p><p><strong>Conclusion: </strong>Our study shows that the regulators of phosphate metabolism in PHPT patients are higher than controls and they significantly reduce after surgical cure. 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引用次数: 0
摘要
目的：甲状旁腺激素控制钙和磷酸盐代谢。后者也受FGF23和1-25(OH)2VitaminD的调控。FGF23基因的多态变异C .716 C . > T先前被发现与肾磷酸盐泄漏/肾结石有关。我们的研究目的是研究原发性甲状旁腺功能亢进（PHPT）患者的磷酸盐代谢及其对骨骼和肾脏的影响。方法：我们回顾性比较了大量散发性PHPT患者（339例）和历史比较队列（HCC 503: Olivetti研究组和Siena骨质疏松症研究）。此外，在51例PHPT患者中，在手术治愈后至少2年，磷酸代谢指标也被重新评估。FGF23基因的C .716 C . > T变体在患者和一小部分对照组中进行了基因分型。结果：PHPT患者血清钙、甲状旁腺激素、碱性磷酸酶、β - c末端末端肽（CTx）、尿钙水平较高，而血清磷酸盐、25oh -维生素ind、肾小球滤过率调整的最大肾小管磷酸盐重吸收（TmPO4/GFR）水平低于HCC患者。PHPT患者的成纤维细胞生长因子23 （FGF23）水平高于对照组。肾结石患者携带716t等位基因的频率高于非肾结石患者（χ2 7.20, p = 0.027）。在术后至少2年重新评估的PHPT患者中，我们观察到1-25(OH)2VitaminD和FGF23的显著降低。根据血清磷酸盐水平中位数，将PHPT患者细分为≤2.8 mg/dL和> 2.8 mg/dL两个亚组。与高磷组相比，低磷组血清钙、甲状旁腺激素、1-25(OH) 2维生素ind、尿钙显著升高，肾结石患病率也显著升高。低磷组的雄虫率显著高于高磷组。结论：我们的研究表明，PHPT患者的磷酸盐代谢调节因子高于对照组，手术治愈后显著降低。低血清磷酸盐的PHPT患者生化和临床表型较差。
Phosphate metabolism in primary hyperparathyroidism: a real-life long-term study.
Purpose: Parathyroid hormone controls calcium and phosphate metabolism. The latter is also regulated by both FGF23 and 1-25(OH)2VitaminD. The polymorphic variant c.716 C > T of the FGF23 gene was previously found to be associated with renal phosphate leak/nephrolithiasis. The aim of our research is to study the metabolism of phosphate in a cohort of patients with primary hyperparathyroidism (PHPT) and its impact on bone and kidney.
Methods: We have retrospectively compared a large sample of sporadic PHPT patients (339) with historical comparison cohort (HCC 503: Olivetti Study Group and Siena Osteoporosis Study). Moreover, in 51 PHPT patients, phosphate metabolism indexes were also revaluated at least 2 years after surgical cure. The variant c.716 C > T of the FGF23 gene was genotyped in patients and in a small sample of the control group.
Results: In PHPT patients we found higher levels of serum calcium, PTH, alkaline phosphatase, beta-C-terminal telopeptide (CTx), urinary calcium, while serum phosphate, 25OH-VitaminD, maximal tubular renal phosphate reabsorption adjusted for glomerular filtration rate (TmPO4/GFR) were lower than what was found in HCC. In PHPT patients fibroblast growth factor 23 (FGF23) levels were higher than in controls. Patients with kidney stones carried the 716 T allele more frequently than patients without it (χ2 7.20, p = 0.027). In PHPT patients revaluated at least 2 years after surgery, we observed a significant reduction of 1-25(OH)2VitaminD and FGF23. According to the median of serum phosphate levels, PHPT patients were subdivided into two subgroups: ≤2.8 mg/dL and > 2.8 mg/dL. The lowest phosphate group had a significantly higher serum calcium, PTH, 1-25(OH)2VitaminD, urinary calcium and a higher prevalence of kidney stones than in the highest phosphate group. The rate of males in the lowest phosphate group was significantly higher than in the highest phosphate group.
Conclusion: Our study shows that the regulators of phosphate metabolism in PHPT patients are higher than controls and they significantly reduce after surgical cure. PHPT patients with low serum phosphate have a worse biochemical and clinical phenotype.
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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