Assessment and Therapy of Five Hundred Five Patients With Primary Hyperparathyroidism

Abstract

Background: The aim of the study was to assess the clinical, biochemical, hormonal, and pathological findings in 505 patients with primary hyperparathyroidism (PHPT).

Methods: Three hundred seventy-four females and 131 males with PHPT were enrolled in this study. Studies include a blood chemistry profile and serum phosphorus, parathyroid hormone (PTH), 25-OHD and 1,25-OHD levels, a 24-h urine collection for measurement of creatinine, calcium, and phosphorus, dual energy X-ray absorptiometry (DXA) studies of lumbar spine, hip and forearm, and pathological findings in 253 patients who had surgery. Standard descriptive analyses were utilized for assessment of data.

Results: All patients had persistent or intermittent hypercalcemia except for three with normocalcemic PHPT. With the exception of a family with the multiple endocrine neoplasia type 1 (MEN1) disorder and another family with familial isolated PHPT, patients had sporadic PHPT. Hypercalciuria was present in patients with and without urolithiasis. Serum PTH levels were increased or normal and unsuppressed in all patients. Twenty-six percent of patients had hypophosphatemia and 70% had subnormal TmP/GFR (tubular maximum for phosphate reabsorption per unit of glomerular filtrate) values. Serum 25-OHD levels were subnormal in 73% of patients and serum 1,25-OHD levels were increased in 23% of patients. DXA measurements in 59% of patients revealed the lowest scores at the one-third radius site. Of the 253 patients who had surgery, 84% had a single adenoma, 14% had multiglandular disease, and 2% had carcinoma.

Conclusions: PHPT continues to be a common sporadic endocrine disorder especially in women. Classical parathyroid-related disorders were present in less than half of patients while there was a greater number of patients with a variety of non-traditional disorders and complaints. Ninety-two percent of patients had mild hypercalcemia, and many had hypercalciuria, subnormal 25-OHD levels, hypophosphatemia, excess phosphorus excretion, and DXA data that revealed a greater loss of cortical bone. Surgery in patients with traditional or classical target disorders generally resulted in clinical improvement whereas successful surgery in patients with non-classical target disorders had variable clinical responses with many not exhibiting an appreciable change in quality of life.

J Endocrinol Metab. 2023;13(2):75-80
doi: https://doi.org/10.14740/jem847