Endocrine Abstracts

Objective: Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders, with a female to male ratio of 3:1. Currently most patients with PHPT are asymptomatic. However, data about the gender impact on the clinical presentation of PHPT are lacking.

Methods: We evaluated the difference in symptoms and biochemical parameters between men and women with PHPT in a single center series of 417 patients.

Results: Male PHPT patients resulted significantly younger (P=0.046) and more frequently symptomatic than women (62.3% vs 47%, P=0.016). Furthermore, renal stone incidence was higher in male than in female patients (50.5% vs 33%, P=0.003) while no difference was found in the incidence of osteitis fibrosa cystica (21.5% vs 20.7%). Instead, osteoporosis, established as T score < 2.5 at any site, was significantly predominant in women (56.5% vs 39.3%, P=0.015) rather than in men. However, no differences were found in classical biochemical disease parameters (i.e. PTH, serum calcium, phosphorus, 24 h-urine for calcium) nor in creatinine and vitamin D levels. Finally, the proportion of patients with surgical indications (symptomatic patients and asymptomatic patients meeting surgical criteria recommended by current guidelines) was similar in male and in female PHPT patients (84,6% vs 84,9%).

Discussion: Gender leads to a different clinical presentation in PHPT patients, male patients being usually younger and more frequently affected by a symptomatic form of the disease. In addition, renal stones are significantly more frequent in men, while in women osteoporosis is prevalent. On the other hand, PHPT biochemical presentation seems not to be influenced by gender. Furthermore, surgical indication is reached equally in male and female PHPT patients.

Conclusions: In male patients PHPT is less frequent but more commonly symptomatic than in female patients. PHPT clinical presentation is influenced by gender, although there are no sex-related differences in its biochemical profile.