Endocrine Abstracts

The more sophisticated laboratory methods are used, the more likely a disease is found at its asymptomatic stage. In particular, diagnosis of primary hyperparathyroidism (PHPT) is currently based not only on the presence of clinical symptoms but on the typical upswing of the serum parathyroid hormone level. Outlooks of patients with PHPT and normal serum calcium level have not been quite clear so far. We tried to contribute to this question in a prospective study that has been in progress in the Czech Republic at a tertiary endocrinology center from January 1st, 2007, till December 31st, 2011. A total of 178 out-patients were diagnosed with PHPT, i.e. parathyroid hormone level was higher than 7.1 ng/l. Initially, the serum calcium level was not higher than 260 mmol/l in 154 cases (normocalcemic patients) and got over this limit in 24 cases (hypercalcemic patients). During a follow-up period, the serum calcium level exceeded 2.60 mmol/l in 22 originally normocalcemic patients. In 19 patients it raised to 2.85 mmol/l or less (moderate increase) and in 3 patients it transcended this value (high increase). In these patients, the increase followed after 1, 2 and 5 years of watching respectively. In a group of 24 patients in whom hypercalcemia was present from the very beginning, parathyroidectomy was performed in 16 cases (66.7%) during the study. In a group of 154 originally normocalcemic patients, parathyroidectomy was performed in 8 patients (5.2%). In normocalcemic patients, parathyreoidectomy was suggested mainly for parathyroid adenoma evidenced by MIBI scintigraphy, exceptionally by a surgeon recommendation finding parathyroid adenoma during thyreoidectomy.

Conclusion: Normocalcemic hyperparathyroidism is a strong reason for a ‘watchful waiting’ above all. Imaging methods, and rarely careful surgeon performing a thyroidectomy, may help to discover a parathyroid adenoma. One must be aware of risks and benefits of all attitudes.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.