[Skip to Navigation]
Views 177
Citations 0
Comment & Response
December 2019

Diagnosis and Management of Hyperparathyroidism—Reply

Author Affiliations
  • 1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
  • 2Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, Texas
  • 3Michael E. DeBakey Department of Surgery, VA Medical Center, Houston, Texas
JAMA Intern Med. 2019;179(12):1733-1734. doi:10.1001/jamainternmed.2019.5087

In Reply We thank Bertocchio and Gaschen et al for their interest in our study,1 their insightful comments, and the opportunity to provide clarifications. First, parathyroid hormone (PTH) can, indeed, be elevated in vitamin D insufficiency, a common cause of secondary hyperparathyroidism (sHPT). Elevated PTH is usually associated with normocalcemia in sHPT, in contrast to primary hyperparathyroidism (pHPT), where elevated PTH is typically associated with hypercalcemia. Therefore, vitamin D insufficiency is unlikely to have misclassified any of the patients in the pHPT cohort based on our inclusion criteria. Indisputably, 25-hydroxy vitamin D level should be part of the clinical evaluation of all patients with suspected pHPT. This is most important in the diagnostic setting of normocalcemic pHPT or in hypercalcemia with normal (but inadequately suppressed) PTH, both of which scenarios were excluded from our cohort.1,2 It should be noted that low 25-hydroxy vitamin D in pHPT is frequently the result of high PTH levels (PTH-mediated conversion of 25-hydroxy vitamin D into 1,25-dihydroxyvitamin D) rather than the cause.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words