Abstract
Current primary hyperparathyroidism (PHPT) clinical presentation is asymptomatic in more than 90% of patients, while symptoms concern osteoporosis and rarely kidney stones. Here, we retrospectively investigated the prevalence of PHPT patients presenting with hypercalcemic-related symptoms (HS-PHPT) as cognitive impairment, changes in sensorium, proximal muscle weakness, nausea and vomiting, constipation, and severe dehydration, in a single center equipped with an emergency department and described their clinical features and outcome in comparison with a series of asymptomatic PHPT out-patients (A-PHPT). From 2006 to 2016, 112 PHPT patients were consecutively diagnosed: 16% (n = 18, 3M/15F) presented with hypercalcemic-related symptoms. Gastrointestinal symptoms occurred in 66% of HS-PHPT patients and cognitive impairment in 44%; one woman experienced hypertensive heart failure. Two-thirds of HS-PHPT patients were hospitalized due to the severity of symptoms. Comparing the clinical features of HS-PHPT patients with A-PHPT patients, no gender differences were detected in the two groups, while HS-PHPT patients were older at diagnosis (71 (61–81) vs. 64 (56–74) years, P=0.04; median (IQR)). HS-PHPT patients presented higher albumin-corrected calcium levels (12.3 (11.3–13.7) vs. 10.6 (10.3–11.3) mg/dl, P < 0.001); 4 HS-PHPT presented corrected calcium levels >14 mg/dl. Serum PTH levels and total alkaline phosphatase activity were higher in HS-PHPT. Reduced kidney function (eGFR < 45 ml/min) was prevalent in HS-PHPT patients (42% vs. 5%, P=0.05). No differences in kidney stones and osteoporosis were detected, as well as in the rates of cardiovascular comorbidities and main cardiovascular risk factors. HS-PHPT patients had an age-adjusted Charlson Comorbidity Index higher than that of the A-PHPT patients and were on chronic therapy with a greater number of medications than A-PHPT patients. In conclusion, hypercalcemic-related symptoms occurred in 16% of PHPT patients. Risk factors were severity of the parathyroid tumor function, multimorbidity, and polypharmacy.
Highlights
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder, after diabetes and thyroid diseases, characterized by an inappropriate secretion of parathyroid hormone (PTH) from parathyroid glands. e incidence of primary hyperparathyroidism (PHPT) significantly increased in the last decades in western countries, probably due to the inclusion of serum calcium level determination in biochemical screening tests for osteoporosis evaluation [1]
Biochemical parameters were assayed by routine methods (Roche modular platform, Roche Diagnostics, Mannheim, Germany); in particular, albumin was measured immunoturbidimetrically, providing measurements similar to those obtained by the bromocresol purple (BCP)-based method [5]. e albumin-corrected serum calcium was calculated according to the following formula: serum total calcium − 0.8 × (serum albumin (g/dL) − 4.0)
Investigating the clinical characteristics of the patients experiencing symptomatic hypercalcemia (HS-PHPT) compared with asymptomatic PHPT out-patients (A-PHPT) patients, HS-PHPT patients emerged as older and presented with a more severe hyperparathyroidism, in terms of higher serum calcium, PTH, and total alkaline phosphatase (ALP) levels, suggesting that hypercalcemia-related symptoms are positively correlated with the parathyroid tumor activity
Summary
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder, after diabetes and thyroid diseases, characterized by an inappropriate secretion of parathyroid hormone (PTH) from parathyroid glands. e incidence of PHPT significantly increased in the last decades in western countries, probably due to the inclusion of serum calcium level determination in biochemical screening tests for osteoporosis evaluation [1]. E incidence of PHPT significantly increased in the last decades in western countries, probably due to the inclusion of serum calcium level determination in biochemical screening tests for osteoporosis evaluation [1]. Even the PHPT clinical presentation has changed from symptomatic disorder, primarily characterized by overt skeletal fragility, kidney stones, and hypercalcemic symptoms, to asymptomatic one, that accounts for more than 90% of cases in USA. E aims of the study were (1) to determine the prevalence of PHPT patients presenting with symptomatic hypercalcemia (HS-PHPT) at a single center equipped with an emergency department; (2) to describe their clinical and biochemical features and outcomes in comparison with a series of asymptomatic PHPT (A-PHPT) out-patients
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