Endocrine Abstracts

Introduction: In the last decades, primary hyperparathyroidism (PHPT) has changed in its clinical presentation, being mostly asymptomatic in western countries; in Romania is still common to see various clinical presentations.

Objective: To characterize a retrospective cohort of PHPT Romanian patients.

Patients and methods: 271 patients were included: 88% women, ratio F/M 7.5/1, mean age 60.6±12 yrs (15–83), mean BMI 26.3±4.9 kg/m² (15.1–43). The biochemistries were measured by automated standard laboratory methods. Serum intact PTH, 25OH-vitamin D, C-telopeptide (CTX) and osteocalcin (OC) were measured by chemiluminescence immunoassay. Areal bone density was measured at the lumbar spine (LS), femoral neck (FN) and distal radius1/3 site (R). Site-matched spine TBS parameters were extracted from the DXA images using TBS iNsight software.

Results: Biochemistries (mean±S.D.) (range): calcium 11.3±1.1 mg/dl (10–18 mg/dl), PTH 266.5±373.9 pg/ml (31–2812 pg/ml), 25OHD 15.2±9.8 ng/ml (4–90.28 ng/ml), CTX 1.2±1.6 ng/ml (0.1–15.8 ng/ml), OC 66.1±19 ng/ml (8.9–609 ng/ml). Simptomatic hypercalcemia was noted in 15% and the prevalence of severe vitamin D deficiency (<10 ng/ml) was 34.7%. Renal involvement (51.7%): nephrolithiasis 47.6% (7.7% had surgery), more likely in males and younger patients; nephrocalcinosis (ultrasound evidence 4.1%); hypercalciuria (30.2%); reduced renal function (13.3%). Skeletal involvement: fractures (26.3%; non-verterbral 17%, vertebral 8.1%, both 1.1%) in significantly older; osteitis fibrosa cystica 2.95%; LS- BMD (224 pts) mean T-score –2.3 S.D., FN- BMD (192 pts) mean T-score –1.8 S.D.; R- BMD (38 pts) mean T-score –2.6 S.D.. The prevalence of osteoporosis by a single site: 45.8% (LS), 20.1% (FN), 63% (R). Mean TBS was in the partially degraded range (1.258±0.115); 32% had degraded microarchitecture (TBS ≤ 1.20), 51% had partially degraded microarchitecture (TBS > 1.20 and < 1.35) and 17% had normal TBS. Etiology (61.6% operated, 91 pts with available histology): adenoma (94.5%, 8 double), carcinoma (3.3%), hyperplastic (2.2%), probably selection bias in refferal to surgery. Mean adenoma weight (68 pts) 3.70±7.78 g (range 0.05 – 48.6 g). Familial forms in 12 pts (4.5%): MEN (1,2) (8 pts), HPP-JT (3 pts), isolated (2 pts).

Conclusion: Currently in Romania there is a mixture of clinical presentations of all described phenotypes.