Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Beside renal and skeletal complications, it has a wide variety of nonspecific symptoms from other organs that may mimic other diseases and delay the diagnosis. Nowadays PHPT evolves to less-symptomatic.

Aim: The aim is to revise symptomatology profile of PHPT in a single region of Poland; and to help early PHPT diagnosis – encouraging interdisciplinary contact between medical professionals.

Methods: We analyzed retrospectively data of 100 patients with PHPT diagnosed in our centre during the past decade: 94 women and six men, aged averagely 57.1 years (S.D. 13.7 years). We evaluated biochemical conditions (hypocalcaemia, hypercalciuria, hypophosphatemia, and PTH level elevation) and clinical manifestations: renal, skeletal, cardiovascular, gastrointestinal, and asymptomatic.

Results: Renal symptoms were present in 55%, as isolated symptoms in 14%. In the course of unrecognized disease seven cases of lithotripsy, seven operative lithotomies, two nephrectomies were performed. Osteoporosis/osteopenia was present in 66 and 10% respectively, and in 35% as the only PHPT presentation. In 16% fragility fractures, in 10% brown tumors were present. Fifty-five percent of PHPT patients were hypertensive and 21% ischemic heart disease positive. Gastrointestinal symptoms were present in 52%, in three cases (5.8% of 52), pancreatitis was documented. The incidental diagnosis of PHPT in asymptomatic patients was held in 15%. Mean serum Ca was 2.87 mmol/l (S.D.: 0.36), mean urine Ca was 15.97 mEq/24 h (S.D. 7.89), mean serum iPTH was: 324.11 pg/ml (S.D. 425.21). The duration time from any symptom appearance to the diagnosis varied between immediate diagnosis (19%), 1–10 years (46%), and >10 years (35%).

Conclusion: PHPT is still diagnosed too late, usually after a long time of untreated symptomatic disease. There is a need of active PHPT search. Multidisciplinary cooperation between specialists on the diagnostic level brings hope to avoid late complications of unrecognized disease.