Zinc copper levels in patients with primary hyperparathyroidism

117 CMJ Original Research June 2021, Volume: 43, Number: 2 Cumhuriyet Tıp Dergisi (Cumhuriyet Medical Journal) 117-123 http://dx.doi.org/10.7197/cmj.884316 Zinc copper levels in patients with primary hyperparathyroidism Primer hiperparatiroidi düzeyleri hastalarında çinko bakır Filiz Alkan Baylan1, Mehmet Bankir2, Fettah Acıbucu3, Metin Kılınç1 Department of Biochemistry, Kahramanmaraş Sütçü İmam University Faculty of Medicine Kahramanmaraş, Turkey. Department of İnternal Medicine, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. 3 Department of Endocrinology and Metabolic Diseases, University of Health Sciences, Adana Health Practices and Research Center, Adana, Turkey Corresponding author: Filiz Alkan Baylan, MD, Department of Biochemistry, Kahramanmaraş Sütçü İmam University Faculty of Medicine Kahramanmaraş, Turkey E-mail: Received/Accepted: February 21, 2021 /June 29, 2021 Conflict of interest: There is not a conflict of interest. 1 2 SUMMARY Objective: Primary hyperparathyroidism (PHPTH) is an endocrine disorder with hypercalcemia due to increased parathormone (PTH) release. This study aims to investigate the relationship between PHPTH and serum zinc and copper levels. Method: 35 patients diagnosed with PHPT and 30 healthy control cases were included in the study. Serum zinc and copper levels were measured in all patients. Results: There was no difference between the groups in terms of age and gender. It was detected that serum Zn levels were significantly lower and serum Cu levels were higher in the PHPTH group compared to the control group (PHPTH Zn: 85.8±24.9 μ/dL, Cu: 81.2±13.8 μ/dL and Control Zn: 103.3±21.3 μ/dL, Cu: 72.6±13.3 μ/dL p = 0.004, p= 0.013, respectively). There was a weak positive correlation between serum Cu levels and PTH levels. Conclusions: Serum zinc and copper levels should be considered in the clarification of the pathogenesis of PHPTH and in treatment planning. Keywords: Primary hyperparathyroidism, zinc, copper Filiz Alkan Baylan Mehmet Bankir Fettah Acıbucu Metin Kılınç ORCID IDs of the authors: F.A.B. 0000-0003-3117-7768 M.B. 0000-0003-3284-2838 F.A. 0000-0002-2252-2112 M.K. 0000-0002-1623-0201 ÖZET Amaç: Primer hiperparatiroidi (PHPTH), artmış parathormon (PTH) salınımına bağlı hiperkalsemi ile seyreden endokrin bozukluktur. Bu çalışma, PHPTH ile serum çinko, bakır düzeyleri arasındaki ilişkiyi araştırmayı amaçlamaktadır. Yöntem: Çalışmaya PHPT tanısı konmuş 35 hasta ve 30 sağlıklı kontrol olgusu dahil edildi. Tüm hastalarda serum çinko ve bakır düzeyleri ölçüldü. Bulgular: Gruplar arasında yaş ve cinsiyet açısından fark yoktu. PHPTH grubunda serum Zn seviyeleri kontrol grubu ile karşılaştırıldığında önemli ölçüde düşük, serum Cu seviyeleri ise yüksek saptandı (sırasıyla PHPTH Zn: 85.8±24.9 μ/dL, Cu: 81.2±13.8 μ/dL ve Kontrol Zn: 103.3±21.3 μ/dL, Cu: 72.6±13.3 μ/dL p = 0.004, p= 0.013). Serum Cu seviyesi ile PTH seviyesi arasında pozitif zayıf korelasyon vardı. Sonuç: Serum çinko ve bakır düzeyleri, PHPTH patogenezinin aydınlatılmasında ve tedavi planlanmasında göz önünde bulundurulmalıdır. Anahtar sözcükler: Primer hiperparatiroidi, çinko, bakır 118 INTRODUCTION Study Population Primary hyperparathyroidism (PHPT), which is the most important cause of hypercalcemia, usually occurs with hypercalcemia and increased parathyroid hormone (PTH) levels. It is caused by excessive synthesis and secretion of PTH by one or more of the four parathyroid glands 1. PTH in bone; regulates osteoclast formation and increases serum Ca+ level. Moreover, PTH stimulates 1-α hydroxylation of the kidney 2. 1.25 D3 increases Ca+ absorption by increasing Ca+ cotransport expression in the mucosa of the small intestine and duodenum. Therefore, PTH and 1.25 D3 are important factors in the regulation of bone remodelling. Zinc (Zn) is also important in bone remodeling. Zn is abundant in bone tissue and 30% of its total is in the bone. Zn stimulates osteoblastic bone formation and mineralization. It inhibits osteoclastic bone resorption by inhibiting osteoclasts-like cell formation from the bone marrow. Additionally, in-vitro mature osteoclast stimulates apoptotic cell death 3. It has been shown that zinc deficiency disrupts bone growth, development and preservation of bone strength. Copper also plays an important role in the regulation of bone growth and skeletal development. Copper induces the formation of the lysine cruciate ligaments in collagen and elastin via lysyl oxidase activation. As a cofactor of antioxidant enzymes, it removes free radicals of bone that cause osteoclast activation 4. In addition, copper directly inhibits osteoclastic bone resorption 5. Copper, increases the total bone strength and helps maintain the optimum state of bone quality 6. 35 patients diagnosed with PHPT in Adana City Hospital between the years of 2012-2017 and 30 healthy control cases were included in the study. Patients diagnosed with multiple endocrine neoplasms, parathyroid cancer, thyroid cancer, hyperparathyroidism-jaw tumor syndrome (HPTJT), familial hypocalciuric hypercalcemia and patients who were admitted to the hospital with a symptom related to calcium and vitamin D metabolism at least 2 weeks before were excluded from the study. Primary hyperparathyroidism was diagnosed in the existence of the two parameters below as; serum calcium being above 0.1 mg/dl, serum iPTH level being higher, higher/normal or normal at a level incompatible with hypercalcemia compared to the laboratory normal 7. There haven’t been any studies conducted on patients with primary hyperparathyroidism related to serum zinc and copper levels which have been studied in many areas in the recent years. Therefore, we aimed to evaluate serum zinc and copper levels in patients with Primary Hyperparathyroidism. We studied the relationship between serum Vit D, Ca, Magnesium (Mg), Phosphate (P) and zinc, copper levels. MATERIAL AND METHODS This cross-sectional study was conducted by Adana Numune Training and Research Hospital, Department of Internal Medicine and Kahramanmaraş Sütcü Imam University Faculty of Medicine Department of Biochemistry. The study protocol was approved by The Local Ethics Comittee (Date: 07 11. 2018, Descision no:5) Written consent was received from all participants. In a study examining the zinc levels in patients with secondary hyperparathyroidism 8, there was a 95.4% difference in zinc levels detected between the secondary hyperparathyroidism groups and the control group. Based on the aforementioned study, power analysis with a test power of 0.95 by accepting the error as 0.05 required the inclusion of 29 patients in each group taking into account the ratio of at least 95.4% in terms of zinc levels. Serum Zinc-Copper Measurements Evaluated Serum Parameters and Fasting blood samples were taken from healthy controls and patients in 10 cc biochemistry gel tubes. These tubes were centrifuged for 5 minutes at 4000 g. T (...truncated)