Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a prevalent endocrinologic disease and the most common cause of hypercalcemia. PHPT usually affects the elderly. PHPT younger than 40 years of age is less frequent. In young patients especially for ones younger than 30 years of age, screening for familial syndromes such as MEN 1 and MEN 2A is recommended. However, in most of the cases genetic tests are negative and evidence for other endocrine components are absent. Herein this study we retrospectively evaluated the data of 322 patients with asymptomatic PHPT patients who were operated and compared the biochemical and clinical features of young patients (<40 years old) with older ones.

Method: This study had a retrospective design. We evaluated the data of the patients who admitted to our university hospital’s endocrinology clinics and diagnosed with PHPT between September 2015-may 2018. According to the clinical guidelines all symptomatic patients and asymptomatic ones who had at least one indication for surgery were operated. There were 346 adenomas belonging to 322 patients in total. The patients were classified into 2 groups regarding age (<40 years or >40 years old as Group 1 and 2, respectively). Two group was compared according to clinical, biochemical and histopathologic features.

Results: There wasn’t any statistically significant difference between groups according to histopathology (adenoma, hyperplasia and carcinoma) (P = 0.065). In both groups there was female predominance, but number of male patients was significantly higher in Group 1 compared to Group 2 (P = 0.004). Serum Ca levels were similar whereas PTH level was higher in Group 1. According to ultrasonographic features, Group 2 had higher prevalence of accompanying thyroid nodules or thyroiditis (P <0.001).Interestingly T scores on femur and total vertebra and prevalence of osteoporosis were similar in between two groups. The percentage of preoperative localization with US and mean size of adenomas were similar. However positive result on MIBI scan was higher in Group 2. median Urinary Ca excretion was higher in Group 1 despite similar vitamin D levels (P = 0.0012).

Conclusion: The phenotype of PHPT in young adults is different from older patients. In our cohort number of male patients, serum PTH, urinary Ca excretion were higher in younger patients.