This is a multicentre retrospective observational study, with the aim to characterize the presentation, management and cure rate of Primary Hyperparathyroidism (PHPT) in Italy. Sixty-one Italian Centres of Endocrinology participated in the study. Clinical, biochemical and instrumental records of 2173 patients with diagnosis of PHPT were collected on a specific online platform (Hyperparanet). Patients were 1808 females (83.2%) and 365 males (16.8%). Diagnosis of PHPT was made at the same centre which followed the patient in 1888 cases (86.9%). PHPT was sporadic in the majority of patients (n = 2044 patients, 94%), in the remaining a familial form was diagnosed including 69 cases of MEN1, 34 cases of FIHP, 3 of HPT-JT, 2 MEN2A and 20 cases of FHH. The age at diagnosis was 61 ± 15 in the whole group and 45 ± 15 in familial patients. Clinical manifestation of the disease were: nephrolithiasis (either symptomatic or imaging detected) in 687 patients (31.6%), osteoporosis (T score <–2.5 at any site) in 1071 patients (49.2%) complicated by clinical fragility fractures in 282 cases (12.9%), symptoms of hypercalcemia in 104 patients (0.04%). Neuropsychiatric symptoms were detected in 244 (11.2%) cases and cerebrovascular accidents in 60 (0.02%). Only 432 patients were considered completely asymptomatic according to the latest guidelines. Mean serum calcium adjusted for albumin was 12 ± 0.1 mg/dl, PTH 129 ± 117 pg/ml, 25OHD 33 ± 20 ng/ml, 24-hours urinary calcium 291 ± 117 mg, without significant differences between sporadic and familial patients. Parathyroid imaging was performed in all centres in the majority of patients, independently of the indication for surgery. Ultrasound was positive in 833/1414 (58.9%), MIBI scintigraphy in 646/1143 (56.5%) and imaging was concordant in 638 cases. 689 (31.7%) underwent parathyroidectomy, performed at the same centre in half of the cases. At histology a single parathyroid adenoma was found in 554/689 cases (80.4%), a double adenoma in 36 (0.05%), a multiglandular disease in 48 (0.07%), an atypical adenoma in 16 (0.02%), a parathyroid carcinoma in 17 (0.02%). In 18 cases no parathyroid tissue was found at neck exploration. The rate of cure was 88.9: a persistence of the disease occurred in 71 cases and recurrence in 5 cases. Seven cases of persistence/recurrence occurred in familial forms, the remaining cases in apparently sporadic disease. PHPT is a common endocrinopathy in Italy, presenting mostly as a sporadic disease, still burden by common even if silent bone and kidney involvement. The cure rate in patients who undergo parathyroidectomy is high, in centres with parathyroid surgery experience.
05 Sep 2020 - 09 Sep 2020