Endocrine Abstracts

Hypothesis: The clinical presentation of primary hyperparathyroidism (PHPT) changed lately but we don’t know if more patients in our population have asymptomatic form of PHPT.

Materials and methods: Medical records of 449 patients with PHPT who were operated in three Medical Centers (Saint-Petersburg, Russia) between Jan 2011– Jun 2018 were screened. We analyzed anthropometric data, laboratory tests (PTH, 25(OH)D, Ca, iCa, P, 24-h calciuria, ALP levels) and imaging tests (US, scintigraphy or CT/MRI scan, DXA).

Results: Most of the patients were women (93.1%), F:M ratio was 13.5:1. The age varied between 23 and 87 years (mean 59), men were younger than women (55 & 60, P=0.02). 310 patients had symptomatic PHPT (osteoporosis (41.9%), urolithiasis (25.5%) and GI lesions), and 139 patients were asymptomatic. Patients with clinical signs were older than asymptomatic ones (P=0.025) and often had cardiovascular pathology (P=0.003). 88% of men with symptomatic PHPT had urolithiasis compared to women who mainly had osteoporosis (64%). Of 449 patients 18 had MEN1, and one had MEN2a. Asymptomatic patients were younger (58 & 60 years, P=0.002) and had higher 25(OH)D level (32.2 & 18.6 ng/ml) compared to symptomatic PHPT patients. Vitamin D status was assessed only for 25% of pts and most of them did not receive supplements. Correlation analysis revealed associations between PTH and serum iCa (r=0.464, P<0.000001), total Ca (r=0.258, P<0.000001), phosphorus (r=−0.313, P=0.000025) and ALP (r=0.334, P=0.02). In addition, 25(OH)D was associated with iCa (r=−0.352, P=0.0007) and Ca (r=−0.412, P=0.03). Adenoma size was associated with the disease duration (r=−0.183, P=0.002), PTH (r=0.367, P<0.000001), iCa (r=0.334, P=<0.000001). Thirty-seven patients had normocalcemic PHPT form, including ten who were asymptomatic and 27 pts with certain manifestations of the disease. The size of adenoma was smaller (P=0.01) and PTH was lower (P<0.0001) than in hypercalciemic patients. In normocalcemic group there were no patients with hypophosphatemia (P=0.04).

Conclusion: Study results showed that in Russian patients PHPT continues to be a symptomatic disease and only 31% of cases are diagnosed using laboratory tests. PHPT is mainly a female disease often with osteoporosis. Half of PHPT men have urolithyasis. It seems that cardiovascular diseases associates with PHPT. Serum 25(OH)D level was rarely assessed and patients did not received vitamin D supplementation.