Primary Hyperparathyroid Stone Disease - A Biochemical and Radiological Analysis in 28 Patients

Abstract

The biochemical tests and radiological features of twenty eight primary hyper-parathyroid stone patients were reviewed. Of the 28 patients, 12 (42.9%) patients had single stone, 11 (39.3%) had multiple stones, and only 5 (17.8%) had florid stones (staghorn stone or nephrocalcinosis). The stone composition of 28 primary hyper-parathyroid stone former were: mixed calcium oxalate and calcium phosphate in 30 (71.4%), pure calcium oxalate in 7 (25%), pure calcium phosphate in 1 (3.6%). Ap-parently, the stone patterns and composition of primary hyperparathyroid stone were not significantly different from idiopathic calcium stone. The sensitivity rate of different biochemical assays for diagnosis of primary hyper-parathyroidism were: 100% in serum total, free calcium and osteocalcin level, PTH MM (96.4%), intact PTH (92.9%), Chloride/phosphorus ratio (89.3%), nephrogenous cyclic AMP (42.9%), 24h urinary calcium excretion (42.9%), calcitonin (21.4%), phos-phorus (17.9%), C terminal PTH (14.3%) and plasma cyclic AMP (0%). After resection of parathyroid adenoma, all patients returned to normocalcemia. During a follow up period from 6 to 36 months, only one patient developed recurrent nephrolithiasis which aws due to concomitant hypocitraturia and had nothing to do with parathyroid hyperfunction. We concluded that serum calcium should be screened in all urolithiasis patients, and parathyroidectomy will offer greatest satisfaction in treat-ing primary hyperparathyroidism.(J Urol R.O.C., 2:372-377, 1991)