Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha.

Xiangbing Wang,Zhiguang Zhou,Lingqiong Meng,Shuying Liu,Zhifeng Sheng,Aseel Al-Dayyeni

doi:10.1155/2018/6282687

Abstract

Purpose To compare the initial clinical features, laboratory values, and bone mineral density among patients with primary hyperparathyroidism (PHPT) in Changsha (China) and New Brunswick (USA). Methods In this retrospective study, we reviewed 169 PHPT patients who presented at Robert Wood Johnson University Hospital and 133 PHPT patients who presented at the Second Xiangya Hospital of Central South University in the same time period. The following characteristics were compared between the groups: age, gender, BMI, serum calcium, alkaline phosphatase (AKP), albumin, intact PTH (iPTH), 25-hydroxyvitamin D (25 (OH) D), fasting blood glucose levels, and bone mineral density (BMD). All these parameters were also compared according to gender and menopausal status. iPTH associations were also assessed along with several other parameters. Results PHPT patients from Changsha had higher serum calcium, iPTH, and AKP levels but lower 25 (OH) D levels than the patients from New Brunswick (p < 0.05). Patients in Changsha had lower T-scores and Z-scores in both the lumbar spine and hip regions than those in New Brunswick (p < 0.05). Patients in New Brunswick had lower percentages of parathyroid adenoma and kidney stones. Serum iPTH level was positively correlated with serum calcium and serum AKP levels in both Changsha and New Brunswick (p < 0.05). Conclusions There are distinct biochemical and clinical differences between patients with PHPT in China and the United States. Our study revealed that Asian PHPT patients from Changsha presented more severe PHPT profiles, lower bone mineral density, and higher incidence of renal stones.

Highlights

The use of multichannel chemistry screening tests in the United States and other Western countries since the 1970s has made primary hyperparathyroidism (PHPT) a more commonly recognized endocrine disease, and it has shifted from being a classically symptomatic disorder to an asymptomatic one [1, 2]
Two PHPT patients from Changsha were diagnosed with parathyroid cancer, while no parathyroid cancer was found in the New Brunswick sample
Fasting glucose was higher in New Brunswick PHPT patients than in those patients from Changsha (p < 0 05, Table 1)

Summary

Introduction

The use of multichannel chemistry screening tests in the United States and other Western countries since the 1970s has made primary hyperparathyroidism (PHPT) a more commonly recognized endocrine disease, and it has shifted from being a classically symptomatic disorder to an asymptomatic one [1, 2]. Most patients with PHPT in the US are asymptomatic as compared with their counterparts in developing Asian countries, such as India and China, who are still characterized with distinct clinical manifestations and severe biochemical markers [3]. International Journal of Endocrinology few data are available on PHPT comparisons between China and the USA. A recent study showed a mild increase in asymptomatic PHPT patients in Shanghai, there were still major differences in clinical presentations between Shanghai (China) and New York City (USA). The PHPT patients from the two cities were from different time periods: Shanghai (2001–2010) and New York (2009–2013). We compared the initial presentation of patients with PHPT from Changsha, China, and New Brunswick, USA, in the same time period. Our current study may provide clues for understanding the role of genetic, environmental, and nutritional factors in the development of PHPT

Methods

Results

Conclusion