Endocrine Abstracts

Objective: Primary hyperparathyroidism (PHPT) is a clinical condition characterized by hypercalcemia-specific symptoms and signs caused by excessive secretion of parathormone. After the evaluation of blood calcium measurements within routine tests, the frequency of hyperparathyroidism increased and there is a marked decrease in the frequency of classical symptoms and signs. Recently, most PHPT cases are detected in the asymptomatic period, and which of these asymptomatic patients will go to surgery,is individually evaluated. In this study, it was investigated whether there is any feature that can be taken into account in the diagnosis and follow-up by considering the calcium course in the period until the development of hypercalcemia.

Methods: The biochemical records of patients who were operated with the diagnosis of PHPT and whose histopathological diagnosis was parathyroid adenoma were reviewed from our database. We evaluated patients who had at least 2 consequtive albumin corrected calcium levels before the time of first hypercalcemia were detected, during the preoperative period. The date when the first hypercalcemia detected, first hypercalcemic value, normocalcemic values and dates, and the intervals between them were recorded. We determined delta change and percentage changes within the patients who had at least 1 year of periyod between normocalcemia values.

Results: In this study,18(94.7%) female and 1(5.3%) male,19 patients with PHPT were included and the mean age was 52.21 ± 10.9. The median time to develop hypercalcemia after the last normocalcemia time was 5 months (0.5–36 months). Median hypercalcemia level was 10.3 mg/dl (10.1–10.9),median for last normocalcemia was 9.8 mg/dl (9.3–10.0). It was found that the development time of hypercalcemia was decreasedas the normal calcium level increased (P = 0.044). A higher hypercalcemic value was found as the time between normocalcemia and hypercalcemia increased (P = 0.049). The course of increase in calcium levels over time was statistically significant (P = 0.0). For the course of changes in normocalcemic values ​​determined in these 19 patients until hypercalcemia was detected, delta change and percentage changes of 12 patients with 2 normocalcemic values ​​at least 1 year intervals before the development of hypercalcemia were calculated.

Conclusion: Recently, some patients with primary hyperparathyroidism who are asymptomatic at the time of admission are treated surgically and some of them are followed up. Individualized treatment is applied in this regard, according to the guidelines some of the patients recommended surgery are followed, some of those recommended for follow-up are also operated. More information about the natural course of untreated primary hyperparathyroidism can help resolve this imprecise situation.