Abstract
In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium +/- SD, 13.6 +/- 1.6 mg/dl), 8 of them (88.8%) defined as symptomatic. The second group comprised 30 patients (mean calcium +/- SD, 12.2 +/- 1.63 mg/dl), 22 of them defined as symptomatic (73.3%). The third group contained 65 patients (mean calcium 11.7 +/- 1.1 mg/dl), 34 of them symptomatic (52.3%). Patients from the first group tended to be younger (mean +/- SD, 43.0 +/- 15 vs 55.1 +/- 14.4 and 55.7 +/- 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 +/- 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 +/- 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.
Highlights
Primary hyperparathyroidism (PHP) is a hypercalcemic disease due to an abnormally increased secretion of parathyroid hormone (PTH) from one or more parathyroid glands. The hallmark of this condition is the presence of high levels of serum calcium and high or inappropriate levels of PTH
In a previous publication we showed a higher incidence of symptomatic patients by the time of diagnosis among Brazilian patients [7]. These differences in clinical presentation of PHP might be related to several causes, including awareness about the disease, availability of laboratory resources and vitamin D status
PHP was diagnosed on the basis of the finding of high levels of total and/or ionized calcium and high or inappropriate PTH levels
Summary
Primary hyperparathyroidism (PHP) is a hypercalcemic disease due to an abnormally increased secretion of parathyroid hormone (PTH) from one or more parathyroid glands. In the United States, most patients with PHP have few or no symptoms at diagnosis [5] and calcium levels are not usually higher than 1 mg/dl above the upper normal limits [6]. PHP was diagnosed on the basis of the finding of high levels of total and/or ionized calcium and high or inappropriate PTH levels.
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