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

Kaderli, Reto Martin; Riss, Philipp; Geroldinger, Angelika; Selberherr, Andreas; Scheuba, Christian; Niederle, Bruno (2017). Factors influencing pre-operative urinary calcium excretion in primary hyperparathyroidism. Clinical endocrinology, 87(1), pp. 97-102. Blackwell Scientific Publications 10.1111/cen.13348

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OBJECTIVE 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. DESIGN The data were collected prospectively. Patients with sporadic PHPT undergoing successful surgery were included in a retrospective analysis. PATIENTS The analysis covered 381 patients with pre-operative workup 2 days before removal of a solitary parathyroid adenoma. MEASUREMENTS The impact of serum Ca and 25-hydroxyvitamin D3 (25-OH D3) on CCCR. RESULTS 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). CONCLUSIONS 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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Kaderli, Reto Martin


600 Technology > 610 Medicine & health




Blackwell Scientific Publications




Lilian Karin Smith-Wirth

Date Deposited:

05 Mar 2018 12:17

Last Modified:

25 Oct 2019 17:08

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

influencing factors primary hyperparathyroidism urinary calcium excretion vitamin D





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