Endocrine Abstracts

Objective: Primary hyperparathyroidism is the third most common endocrine disorder, which often causes hypercalcemia in outpatient cases. This study aimed to evaluate the various demographic and clinical characteristics, biochemical data, as well as the prevalence of associated conditions, diagnostic accuracy of imaging modalities, and treatment outcomes in patients with APHPT.

Methods: We analyzed data collected from 168 individuals diagnosed with APHPT and treated at Riga East Clinical University Hospital from January 2021 to January 2024. This involved thoroughly examining their medical records, laboratory results, imaging scans, and surgical procedures. Statistical analysis was conducted using IBM SPSS 29.0.

Results: 168 patients (mean age: 63.7±11.8 years), 86.3% were females, 13.7% – males. The mean preoperative maximal calcium level was 2.9±0.3 mmol/l, iPTH level – 247.6±224.9 pg/mL, minimal phosphorus – 1.3±6.7 mmol/l and 25-OH vitamin D level 28.3±14.7 ng/mL. A positive correlation was observed between preoperative calcium levels and adenoma cross-sectional area (rs=0.187, P=0.029) and maximal dimension (rs=0.215, P=0.011). Ultrasonography verified parathyroid adenomas in 63.9% (107/168), SPECT/CT – 68.4% (52/76), 99mTc-sestamibi scan – 65.6% (61/93), 3D-CT - 70.6% (24/34), contrast-enhanced ultrasonography (CEUS) – 84% (21/25) and MRI in 40% (2/5) cases. 12.5% (n=21) of patients had unlocated parathyroid adenoma. 22.0% (n=37) of patients had kidney stones, 17.3% (n=29) – gallstones, 34.5% (n=58) – osteoporosis, 12.5% (n=21) – osteoporotic fractures and 47.6% (n=80) – osteopenia. 17.9% (n=30) of patients received oral bisphosphonates, 4.0% (n=7) intravenous bisphosphonates, 8.0% (n=14) denosumab, and 1.1% (n=2) had medication holidays. 80.4% (n=135) of patients had thyroid nodules, 48.2% (n=81) had nontoxic goitre, 24.4% (n=31) had autoimmune thyroiditis, 41.7% (n=70) had hypertension and 10.5% (n=18) type 2 diabetes. 18.5% (n=31) of patients were found to have a diagnosis of malignancy. 61.9% (n=104) underwent parathyroidectomy. Histopathology and radiologic imaging of operated patients revealed a single parathyroid adenoma in 93.3% (n=97), double parathyroid adenomas in 1.9% (n=2), parathyroid hyperplasia in 2.9% (n=3) and parathyroid carcinoma in 1.9% (n=2) patients. The mean maximal postoperative calcium level (n=103) was 2.4±0.1 mmol/l, iPTH (n=101) 63.5±27.7 pg/mL, 25-OH vitamin D 41.5±13.3 ng/mL and mean minimal phosphorus (n=56) 1.1±0.2 mmol/l. 3 patients developed hungry bone syndrome following parathyroidectomy.

Conclusion: Our findings highlight the complex nature of APHPT and emphasize the importance of recognizing complications and associated conditions to optimize outcomes for APHPT patients.