I have an appointment with my neuro tomorrow to discuss some of this. One of the things I expect is an agreement that I should see an endocrinologist just to figure out what is real. So I started looking at the local endos to see if any stood out. There aren't many in my little town and I didn't have any hopes of anything special. I settled on one that got two favorable ratings. He was the only rated one in town. He had a short bio on his website. Seemed normal enough and it mentioned that had one journal publication to his credit, but no link, no title. I went to Medline and found it from five years ago. Checkit out...


1. Endocr Pract. 2005 Jan-Feb;11(1):37-42.

Urinary calcium excretion in primary hyperparathyroidism: relationship to
25-hydroxyvitamin d status.

Bussey AD, Bruder JM.

Division of Endocrinology, University of Texas Health Science Center, San
Antonio, TX 78284-7877, USA.

OBJECTIVE: To determine the prevalence of vitamin D deficiency in patients with
primary hyperparathyroidism (PHPT) and evaluate the relationship between urinary
calcium excretion and serum 25-hydroxyvitamin D (25-OH-D) levels in patients with
PHPT. METHODS: We present a case report and a review of the medical records of
patients with PHPT. Of 75 patients with PHPT substantiated by hypercalcemia and
increased levels of intact parathyroid hormone (iPTH), 35 were identified with
laboratory evaluation of vitamin D levels and 24-hour urinary calcium excretion.
These study subjects were stratified as 25-OH-D deficient, insufficient, or
replete (on the basis of serum values of <15, 15 to 25, or >25 ng/mL,
respectively). Total 24-hour urinary calcium excretion and the fractional
excretion of calcium (FECa) were analyzed as a function of 25-OH-D status.
RESULTS: Of the 35 study subjects, 14 (40%) and 13 (37%) had 25-OH-D deficiency
or insufficiency, respectively. Those patients with a 25-OH-D level <15 ng/mL had
higher serum iPTH concentrations as well as lower urinary calcium excretion and
FECa. No significant correlations were found, however, between 25-OH-D status and
iPTH concentrations (r = -0.21; P = 0.23), total 24-hour urinary calcium
excretion (r = 0.07; P = 0.7), or FECa (r = 0.04; P = 0.8). CONCLUSION: Vitamin D
deficiency (25-OH-D levels <15 ng/mL) was common in our population of patients
with PHPT. Urinary calcium excretion was not significantly altered by 25-OH-D
deficiency in patients with newly recognized PHPT. Measurements of total urinary
calcium excretion and FECa can be reliably used to rule out familial benign
hypocalciuric hypercalcemia in the initial evaluation of PHPT, regardless of
25-OH-D status. Determining 25-OH-D concentrations best assesses the vitamin D
status.

PMID: 16033734 [PubMed - indexed for MEDLINE]