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Clin Endocrinol (Oxf). 2017 Jul;87(1):97-102. doi: 10.1111/cen.13348. Epub 2017 May 5.

Factors influencing pre-operative urinary calcium excretion in primary hyperparathyroidism.

Author information

Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Wien, Austria.
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Wien, Austria.



Normal or elevated 24-hour urinary calcium (Ca) excretion is a diagnostic marker in primary hyperparathyroidism (PHPT). It is used to distinguish familial hypocalciuric hypercalcaemia (FHH) from PHPT by calculating the Ca/creatinine clearance ratio (CCCR). The variance of CCCR in patients with PHPT is considerable. The aim of this study was to analyse the parameters affecting CCCR in patients with PHPT.


The data were collected prospectively. Patients with sporadic PHPT undergoing successful surgery were included in a retrospective analysis.


The analysis covered 381 patients with pre-operative workup 2 days before removal of a solitary parathyroid adenoma.


The impact of serum Ca and 25-hydroxyvitamin D3 (25-OH D3) on CCCR.


The coefficient of determination (R2 ) in the multivariable model for CCCR consisting of age, Ca, 25-OH D3, 1,25-dihydroxyvitamin D3 (1,25-(OH)2 D3), testosterone (separately for males and females), intact parathyroid hormone (iPTH) and osteocalcin was 25.8%. The only significant parameters in the multivariable analysis were 1,25-(OH)2 D3 and osteocalcin with a drop in R2 of 15.4% (P<.001) and 2.4% (P=.006), respectively. Bone mineral densities at the lumbar spine, distal radius and left femoral neck were not associated with CCCR (r=-.08, r=-.10 and r=-0.09).


In multivariable analysis, 1,25-(OH)2 D3 and osteocalcin were the only factors correlating with CCCR. Vitamin D3 replacement may therefore impair the diagnostic value of CCCR and increase the importance of close monitoring of urinary Ca excretion during treatment.


influencing factors; primary hyperparathyroidism; urinary calcium excretion; vitamin D

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