Asymptomatic primary hyperparathyroidism: current indications for final solution
Helena Šiprová1,3 & Zdenek Fryšák2,3
Primary hyperparathyroidism (PHPT) belongs to the most common endocrine disorders. It is increasingly reported in patients without any symptoms and hypercalcemia. In the 3rd international workshop on asymptomatic PHPT (Orlando 2008) the normocalcemic PHPT was recognised as a stand-alone entity that needs more attention.
Aim: The purpose of this study is to analyse data from patients with normocalcemic asymptomatic PHPT and to create an effective source database for a future prospective study.
Methods: Data acquired from a group of eligible normocalcemic asymptomatic PHPT patients that were diagnosed in two tertiary endocrinologic centres in the Czech Republic during the last 3 years has been analysed.
Results: The study included 128 normocalcemic asymptomatic PHPT patients age between 20 and 86 (median 64), 18 males and 110 females. The range of serum PTH was 7.237.9 ng/l with the median of 9.5 (reference range 1.57.1). The serum calcium levels varied at the baseline visit between 2.08 and 2.60 mmol/l (median 2.43, reference range 2.052.60). The serum phosphate levels ranged from 0.53 to 1.81 mmol/l (median 1.0, reference range 0.91.32). Alkaline phosphatase and vitamin D, as well as bone density have been monitored. A slight but statistically significant association between the serum phosphate and serum parathyroid hormone levels has been found (Spearmans rank correlation coefficient −0.208). During the follow-up period, some patients with repeatedly normal calcium levels have developed hypercalcemia and a surgical intervention was inevitable, including the elderly patients.
Conclusions: Females highly prevail among patients with normocalcemic asymptomatic PHPT and the average age of these patients is high. It should be verified whether low plasma phosphates may be sufficient to indicate the examination of the levels of PTH. The results of the cross-sectional retrospective study support the usefulness of a wider longitudinal prospective follow-up study focused also to elderly people.