Endocrine Abstracts

Objective: To know the prevalence of primary hyperparathyroidism (PHPT) in urolithiasis and predictors of PHPT in urolithiasis.

Methods: This cross sectional study was conducted between July 2005 and July 2012 in department of endocrinology and urology at our hospital. In this study a total of 165 consecutive patients with urolithiasis with radioopaque stones were evaluated for clinical and biochemical profile. Stones retrieved were analyzed for type of stone using infrared spectroscopy.

Results: Out of these 165 patients, 123 were males, 42 females, with a mean age of 34.5±12.1 years. Eleven patients (7%) had histopathologically proven PHPT. Mean age of these patients was 45.6±12.4 years with male: female ratio of 4:7. Prevalence of bone pains, backache, fracture, weakness, fatigability, joint pain, and myopathy were more common in PHPT group. Three (35%) patients in PHPT and 3 (2%) in non PHPT group had nephrocalcinosis (P<0.0001). Simultaneous renal and ureteric stones were significantly more common in PHPT patients (P<0.0001). Calcific pancreatitis was found in 2 (18.1%) patients with PHPT as compared to 1 (0.6%) in non PHPT group (P value 0.0001).

Mean serum calcium in PHPT group was 12.3±0.3, 9.2±0.03 g/dl in non PHPT group (P<0.0001), Alkaline phosphatase was 312.5±73.9 vs 114.3±2.6 IU/l (P<0.0001) and phosphate was 3.3±0.3 vs 3.7±0.5 g/dl (P value=0.4), iPTH levels were 398.9±132.4 vs 49.3±3.1 pg/ml (P<0.0001) respectively. Calcium oxalates were the most common type of stones in either of the groups (85.3 vs 69.1%) respectively.

Discussion: The prevalence of PHPT in our patient with urolithiasis is 7%. Urolithiasis is more common in males but prevalence of PHPT is more common in females with urolithiasis. Urolithiasis patients with PTPH are older with additional symptomatology. Serum calcium, alkaline phosphate, parathyroid hormone levels were predictors of PHPT. Nephrocalcinosis, concomitant ureteric and renal stones and calcific pancreatitis were predictors of PHPT in urolithiasis patients.

Conclusion: PHPT should be considered as an etiologic factor in urolithiasis.