Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a result of overproduction of parathyroid hormone with pathologically changed parathyroid glands (PTG) and calcium-phosphorus metabolism disorders. Until now, PHPT is often detected late (in countries where there is no screening for hypercalcemia), when there are irreversible complications it manifested.

Materials and methods: One hundred and nine patients with PHPT (mean age: 52.2±8.7 years, duration disease: 8.6+4.3 years) were included in the retrospective study. The control group consisted of 55 age, gender matched subjects. Questionnaire survey (anamnesis data, risk factors for osteoporosis), parameters of calcium-phosphorus metabolism (PTH, Ca, Ca², P), bone markers (alkaline phosphatase, N-MID osteocalcin, β-CTX), sonography of the thyroid (PTG), scintigraphy PTG, bone mineral density (BMD) were examined.

Results: Among the examined patients the male-female ratio was 1:15 (7:102). Premenopausal women represented 28.4% (29) of the examined patients; postmenopausal women -71% (73). Mild PHPT was revealed in 23% patients, symptomatic PHPT – in 77%. Visceral form of disease was diagnosed in 21% patients, bone disorders – in 21% surveyed, mixed forms – in 35%. Low bone mineral density was detected in 75.9% (34.5%, osteoporosis; 41.4%, osteopenia) patients with PHPT; in the control group: 29.2 and 16.7% respectively. Clinical manifestations of symptomatic PHPT were: urolithiasis in 21% patients, cholelithiasis, 5.6%; a stomach ulcer and duodenal ulcer, 6.7%; fragility fractures had 11% of the examined patients.

Conclusion: The results of the retrospective study suggest the late diagnosis of PHPT, mostly the manifest forms associated with complications of PHPT and the low diagnostic rate of mild forms of PHPT, which necessitates the introduction of screening for hypercalcemia.