MP82-07 PRIMARY HYPERPARATHYROIDISM: CHALLENGES IN SCREENING AND DIAGNOSIS IN KIDNEY STONE FORMERS

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2016MP82-07 PRIMARY HYPERPARATHYROIDISM: CHALLENGES IN SCREENING AND DIAGNOSIS IN KIDNEY STONE FORMERS Leslee Matheny, Tracy Marien, Mustafa Kadihasanoglu, and Nicole L. Miller Leslee MathenyLeslee Matheny More articles by this author , Tracy MarienTracy Marien More articles by this author , Mustafa KadihasanogluMustafa Kadihasanoglu More articles by this author , and Nicole L. MillerNicole L. Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2148AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Approximately 5% of patients with kidney stones have primary hyperparathyroidism (PHPT) and 15-20% of patients with hyperparathyroidism form kidney stones. Patients with PHPT can have intermittently elevated serum calcium and parathyroid hormone (PTH) levels, making the diagnosis challenging. The aim of this series is to characterize the work-up for stone formers (SFs) who were eventually diagnosed with PHPT. METHODS A retrospective chart review was performed on all patients seen in our stone clinic with a diagnosis of nephrolithiasis and PHPT between 2009 and 2014. Data was captured regarding work-up of PHPT and subsequent management. RESULTS A total of 111 patients were identified with a history of kidney stones, PHPT and complete work-up. Ninety-three (84%) were diagnosed with kidney stones first and later found to have PHPT. Only 52 (56%) were found to be hypercalcemic on initial metabolic workup (Table 1). Thirty-seven (90%) of the remaining 41 later became hypercalcemic after serum calcium was repeated anywhere from 1-50 times. Seventy-six (82%) patients had elevated PTH on initial evaluation, and the rest were found to have an elevated PTH after an average of 2.1 (1-6) additional tests. Four patients were diagnosed with normocalcemic PHPT. Sixty-six (71%) patients were treated surgically on last follow-up. Patients who presented with hypercalcemia underwent surgical treatment for PHPT sooner after initial presentation than those presenting with normocalcemia (16 versus 54 months, P = 0.0002). No factor was associated with being hypercalcemic on initial evaluation (Table 2). CONCLUSIONS Fluctuating serum calcium and parathyroid hormone levels make diagnosing PHPT challenging. Presenting with normocalcemia delays diagnosis and definitive management of PHPT. Ultimately, a high level of suspicion is necessary to re-screen patients for PHPT when a serum calcium and/or PTH level has already been tested and was normal. Further studies are necessary and ongoing to guide practitioners on screening strategy for PHPT in their patients with nephrolithiasis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1075 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Leslee Matheny More articles by this author Tracy Marien More articles by this author Mustafa Kadihasanoglu More articles by this author Nicole L. Miller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...