Endocrine Abstracts

Introduction: Primary hyperparathyroidism is nowadays frequently diagnosed due to routine blood calcium measured in the general biochemical profile. Primary hyperparathyroidism may be due to a parathyroid adenoma or parathyroid hyperplasia. Parathyroid adenoma may occur in the area of the parathyroid glands or may be ectopic.

Aim: The aim was to describe the differential clinical expression of primary hyperparathyroidism due to an adenoma or hyperplasia in a cohort of patients with the disease.

Methods: A cohort of 21 patient, aged 52–75 years old, 14 female and 7 male, suffering from primary hyperparathyroidism is described. Patients were diagnosed after diagnostic evaluation for various reasons which revealed an elevated blood calcium level. Subsequent evaluation revealed high PTH levels and the diagnosis of primary hyperparathyroidism was made. Further diagnostic evaluation to locate any hyperfunctioning parathyroid glands was made with neck ultrasound and scintigraphy with ^99mTc-Sestamibi.

Results: In 19 of the patients a parathyroid adenoma was localized. In 17 of the cases it was in the area of the parathyroid glands, while in 2 of the patients it was in the upper mediastinum. In 2 of the patients, one male and one female the diagnostic evaluation did not reveal a parathyroid adenoma. In the cases with a parathyroid adenoma PTH levels were elevated, ranging from 121 pg/ml to 345 pg/ml. Calcium levels were also elevated, ranging from 10.8 to 13.5 mg/dl. In the cases, in which no parathyroid adenoma could not be localized, the diagnosis of parathyroid hyperplasia was made. PTH levels were only mildly elevated ranging from 75 to 88 pg/ml and calcium levels were also mildly elevated ranging from 10.6 to 10.9 mg/dl. One of the patients with the presumptive diagnosis of parathyroid hyperplasia decided to have surgery. One of the parathyroid glands was excised. The histology revealed parathyroid hyperplasia. The biochemical picture did not improve and conservative management was decided.

Conclusions: In conclusion, it appears that primary hyperparathyroidism due to a parathyroid adenoma is characterized by elevated levels of PTH and blood calcium in contradiction to parathyroid hyperplasia which is characterized by a milder clinical picture, PTH and calcium both mildly elevated. We propose that in the cases with a presumptive diagnosis of parathyroid hyperplasia, with a mild clinical picture, conservative management should be preferred along with careful follow-up.