Abstract
PurposeThe purpose of this study was to demonstrate the high number of kidney stones in primary hyperparathyroidism (PHPT) and the low number of in fact “asymptomatic” patients.MethodsForty patients with PHPT (28 female, 12 male; median age 58 (range 33–80) years; interquartile range 17 years [51–68]) without known symptoms of kidney stones prospectively underwent multidetector computed tomography (MDCT) and ultrasound (US) examinations of the urinary tract prior to parathyroid surgery. Images were evaluated for the presence and absence of stones, as well as for the number of stones and sizes in the long axis. The MDCT and US examinations were interpreted by two experienced radiologists who were blinded to all clinical and biochemical data. Statistical analysis was performed using the Wilcoxon signed-rank test.ResultsUS revealed a total of 4 kidney stones in 4 (10 %) of 40 patients (median size 6.5 mm, interquartile range 11.5 mm). MDCT showed a total of 41 stones (median size was 3 mm, interquartile range 2.25 mm) in 15 (38 %) of 40 patients. The number of kidney stones detected with MDCT was significantly higher compared to US (p = 0.00124).ConclusionsMDCT is a highly sensitive method for the detection of “silent” kidney stones in patients with PHPT. By widely applying this method, the number of asymptomatic courses of PHPT may be substantially reduced. MDCT should be used primarily to detect kidney stones in PHPT and to exclude asymptomatic PHPT.
Highlights
Asymptomatic primary hyperparathyroidism (PHPT) is defined as biochemically verified PHPT that lacks specific symptoms or signs traditionally associated with hypercalcemia or parathyroid hormone excess [1]
A kidney stone was suspected with US, but this stone failed to be detected with multidetector computed tomography (MDCT)
In whom numerous calculi were seen with MDCT, only one was found to have a kidney stone with US, measuring 15 mm in diameter
Summary
Asymptomatic primary hyperparathyroidism (PHPT) is defined as biochemically verified PHPT that lacks specific symptoms or signs traditionally associated with hypercalcemia or parathyroid hormone excess [1]. Patients with PHPT and kidney stone disease are symptomatic by definition. Those patients are at a 15 to 30 % higher risk to develop kidney stones than the general population, in which an incidence of 1 % is described [2,3,4,5,6]. Calculi burden and new stone formation is important in the clinical evaluation of patients with kidney stone disease in PHPT [12]. The most sensitive method for evaluation of kidney stones has to be used to reveal persistent or recurrent (newly formed) kidney stones after successful parathyroid surgery [13,14,15]
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