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Abstract
BackgroundPrimary hyperparathyroidism is a common endocrine disorder. Hypercalcemia with normal PTH levels is very unusual and can lead to diagnostic difficulties. There are very few very few studies in the literature and all with limited numerical samples. The goal of the present study was to determine the real incidence and characteristics of primary hyperparathyroidism with normal PTH and to evaluate if intraoperative PTH testing is useful in these patients.MethodsWe performed a retrospective review of 314 patients who had undergone parathyroidectomy to treat primary hyperparathyroidism between January 2002 and December 2016. Patients were divided in two groups according to biochemical preoperative findings: in Group A were included patients with normal serum PTH, in Group B those with increased serum PTH.ResultsNine patients (3.7%) were included in group A and 235 in group B. Patients in group A were younger (51.5 ± 12.9 years vs 59.6 ± 12.5); preoperative serum calcium and the incidence of coexisting thyroid disease were similar between the two groups. Symptomatic patients were more frequent in Group A (77.8% vs 39.1%; p = 0.048). There were no significant differences regarding preoperative localization studies and surgical procedure. Intraoperative PTH determination demonstrated sensitivity of 86% in group A and 97% in group B, specificity and positive predictive value of 100% in both the groups, negative predictive value of 67% in group A and 79% in group B. Histopathological examination demonstrated a single gland disease in 8 (88.9%) patients in group A and a multi gland disease in 1 (11.1%), in group B single gland disease was found in 218 (92.8%) patients and multi gland disease in 17 (7.2%). Unsuccessful surgery with persistent or recurrent hyperparathyroidism occurred in 1 (11.1%) patient in group A and 4 (1.7%) in group B.ConclusionsPrimary hyperparathyroidism with normal PTH is rare but physicians should be aware of this possibility in patients with hypercalcaemia. Patients with normal PTH levels are younger and more frequently symptomatic. Intraoperative PTH testing plays an important role in the operative management even in such patients.
Highlights
Primary hyperparathyroidism is a common endocrine disorder
While normocalcemic hyperparathyroidism is well recognized in Primary hyperparathyroidism (PHP), less is known about patients with high calcium but normal intact-parathyroid hormone (iPTH) possibly leading to diagnostic difficulties [1, 3, 9, 10, 12,13,14]
Patients with preoperative PHP diagnosis were included in this study: 61 patients in which diagnosis was made during neck surgery for other diseases as well as 10 patients with persistent or recurrent PHP were excluded from the study
Summary
Primary hyperparathyroidism is a common endocrine disorder. Hypercalcemia with normal PTH levels is very unusual and can lead to diagnostic difficulties. While normocalcemic hyperparathyroidism is well recognized in PHP, less is known about patients with high calcium but normal iPTH possibly leading to diagnostic difficulties [1, 3, 9, 10, 12,13,14]. The literature on this condition is poor and consists mainly of clinical cases [3, 4, 12,13,14,15,16]. Previous studies have suggested that this condition is a less symptomatic, lighter and weaker form of PHP [18]
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