Abstract
The chloride/phosphate ratio (Cl/PO4) has been suggested to have a role in primary hyperparathyroidism (PHPT), but the associations between Cl/PO4 combined with ALP level and PHPT has not been well-studied. Our aim was to investigate the predictive value of combination Cl/PO4 with ALP for PHPT. A cross-sectional retrospective analysis was conducted to examine 172 patients diagnosed with PHPT categorized into two groups: normocalcaemic primary hyperparathyroidism (NPHPT) group and hypercalcaemia PHPT group. We found that Cl/PO4 levels and ALP levels in the NPHPT and hypercalcaemia PHPT group were both significantly higher than normal controls. Cl/PO4 and ALP levels were an independent risk factor for PHPT. Cl/PO4 combined with ALP increased the receiver-operating characteristic curves (ROC-AUC) and the diagnostic value in NPHPT and hypercalcaemia PHPT group (0.913; 95% CI, 0.744–1.000 and 0.932; 95% CI, 0.897–0.966, respectively), specificity of 92.8% and sensitivity of 98%. In conclusion, combination Cl/PO4 with ALP might be a low-cost, simple, available predictive marker of PHPT in Chinese individuals, particularly Chinese remote region where the method used to measure PTH cannot be done. Moreover, due to serum calcium level in NPHPT, Cl/PO4 combined with ALP level measurement have great potential to predict significant occurrence of NPHPT.
Highlights
Primary hyperparathyroidism (PHPT) is characterised biochemically by an inappropriately elevated parathyroid hormone (PTH) level and it is one of the most common endocrine disorders affecting human health[1]
Some Chinese remote areas had no equipment measuring PTH, Simultaneously, serum calcium was measured in most hospitals, but serum calcium level was normal in the normocalcaemic primary hyperparathyroidism (NPHPT) patients
PHPT was subdivided into normocalcaemic primary hyperparathyroidism (NPHPT) and hypercalcaemia groups according to the serum calcium level
Summary
Primary hyperparathyroidism (PHPT) is characterised biochemically by an inappropriately elevated parathyroid hormone (PTH) level and it is one of the most common endocrine disorders affecting human health[1]. Elevated PTH and hypercalcaemia are the diagnostic markers of PHPT3. Several studies have used the oral calcium load to diagnose PHPT inpatients with NPHPT and asymptomatic patients[4, 5]. Some Chinese remote areas had no equipment measuring PTH, Simultaneously, serum calcium was measured in most hospitals, but serum calcium level was normal in the NPHPT patients. The serum ALP level is elevated in 96% of patients with primary hyperparathyroidism[13]. There have been no study evaluating predicting diagnostic value of Cl/PO4 combined with ALP in PHPT. This study investigated the value of the two indicators combinatiom measurement as an auxiliary diagnostic method for PHPT diagnosis in a Chinese population, especially for predicting significant occurrence of NPHPT
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