Algengi og orsakir afleidds kalkvakaóhófs meðal fullorðinna á höfuðborgarsvæðinu
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Issue Date
2005-02-01
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Prevalence of secondary hyperparathyroidism (SHPT) and causal factors in adult population in Reykjavík areaCitation
Læknablaðið 2005, 91(2):161-9Abstract
INTRODUCTION: SHPT is a consequence of decreased concentration of ionized calcium in blood, which may have many causes. The purpose of this study was to assess the prevalence and contributing factors of SHPT in an adult Icelandic population and explore the relationship between PTH and other variables which might explain age related increase in PTH. Such knowledge might be helpful in evaluating the results of PTH measurements. METHODS AND STUDY GROUP: The study group was a random sample of men and women in the Reykjavik area, 30-85 years of age. Serum PTH was measured by ECLIA (Roche Diagnostics), serum 25(OH)D by RIA (DiaSorin), and body composition by DXA. SHPT was defined as PTH >65 ng/l and ionized calcium <1.25 mmol/l. Inadequate vitamin D was defined as serum 25(OH)D 25-45 nmol/l and vitamin D deficiency <25 nmol/l, inadequate calcium intake <800 mg/day (from questionnaire) and reduced kidney function as serum cystatin-C >1.55 ng/l. The relationship between PTH and other variables was assessed by Spearman?s correlation coefficient and linear regression. RESULTS: Of 2,310 individuals invited 1,630 attended (70%), 586 men and 1,023 women. Further 21 were excluded because of primary hyperparathyroidism. Of the total group 6.6% did have SHPT, 7.7% of the women and 4.6% of men (p<0.01 by gender). Underlying causes were identified in 90% of cases, most commonly inadequate vitamin D (73%). Other important causes were obesity, inadequate calcium intake, reduced kidney function and furosemide intake. Many individuals did have more than one possible underlying cause. The concentration of PTH was found in a multivariate linear regression to be associated with age, ionized calcium, 25(OH)D, cystatin-C, smoking, and BMI, especially fat mass. Testosterone did have a weak negative relationship with PTH in men. CONCLUSIONS: Most cases of SHPT could be explained by known causes and far the commonest was inadequate vitamin D. The prevalence of SHPT in Iceland is probably higher than described elsewhere, possibly due to less sunlight exposure. These results would suggest that a greater intake of vitamin D is needed in Iceland. The relationship of PTH with body composition, especially fat mass, sex hormones and smoking, needs further evaluation.Inngangur: Afleitt kalkvakaóhóf (secondary hyperparathyroidism) má rekja til lækkunar á styrk jónaðs kalsíum í blóði sem getur stafað af ýmsum orsökum. Tilgangur þessarar rannsóknar var að kanna algengi og orsakir afleidds kalkvakaóhófs meðal fullorðinna á höfuðborgarsvæðinu og tengsl kalkkirtlahormóns við breytur sem kunna að skýra aldursbundna hækkun þess. Slík þekking hefði klíníska þýðingu við túlkun á niðurstöðum mælinga á PTH (parathyroid hormone ? kalkvakaóhóf). Efniviður og aðferðir: Gögn voru fengin úr þversniðsrannsókn á slembiúrtaki af fullorðnum einstaklingum á höfuðborgarsvæðinu sem framkvæmd var frá febrúar 2001 til janúar 2003. Þátttakendur svöruðu ítarlegum spurningalista varðandi heilsufar, lífsstíl og matarvenjur. Teknar voru blóðprufur, hæð og þyngd mæld og líkamssamsetning. PTH var mælt með ECLIA aðferð (Roche Diagnostics). Líkamssamsetning var mæld með DXA (dual energy X-ray absorptiometry). Greiningarskilmerki fyrir afleiddu kalkvakaóhófi voru PTH >65 ng/l og jónað kalsíum <1,25 mmól/l. Ónógt D-vítamín var skilgreint sem 25(OH)D milli 25 og 45 nmól/l (RIA), D-vítamínskortur skilgreindur sem 25(OH)D <25 nmól/l, ónóg kalkinntaka <800 mg/dag (samkvæmt spurningalista) og skert nýrnastarfsemi sem cystatín-C >1,55 mg/l. Við athuguðum fylgni PTH við aðrar breytur með fylgnistuðli Spearmans og línulegri aðhvarfsgreiningu. Niðurstöður: Alls var 2310 einstaklingum á aldrinum 30-85 ára boðin þátttaka, 1630 (um það bil 70%) mættu, þar af 586 karlar og 1023 konur. Af þessum hópi var 21 einstaklingur útilokaður frá þátttöku vegna frumkalkvakaóhófs. Við fundum 106 (6,6%) einstaklinga með afleitt kalkvakaóhóf, 79 (7,7%) konur og 27 (4,6%) karlar (p<0,01 milli kynja). Hugsanleg skýring fannst í flestum tilfellum (90,6%) og var D-vítamínskortur eða ónóg D-vítamínneysla algengustu orsakirnar (73%). Aðrar mikilvægar orsakir voru hár líkamsþyngdarstuðull, ónóg kalkinntaka, skert nýrnastarfsemi og notkun fúrósemíðs. Margir höfðu fleiri en eina hugsanlega orsök. PTH hafði marktæk tengsl við aldur og marktæka hlutafylgni við jónað kalsíum, 25(OH)D, cystatín-C, líkamsþyngdarstuðul, reykingar, fitumassa og fitulausan massa, leiðrétt fyrir aldri. Testósterón hafði veik markverð neikvæð tengsl við PTH hjá körlum, leiðrétt fyrir aldri. Ályktanir: Unnt var að skýra flest tilfelli afleidds kalkvakaóhófs með þekktum orsökum. Líklega er algengi hærra hér en annars staðar, meðal annars vegna minna sólarljóss. Ónógt D-vítamín var langalgengasta orsökin og því mikilvægt að herða áróður fyrir aukinni D-vítamínneyslu. Tengsl PTH við líkamssamsetningu, kynhormón og reykingar þarf að kanna nánar.
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