Patients with normocalcemic versus hypercalcemic hyperparathyroidism: What's really the difference?

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-21 DOI:10.1016/j.amjsurg.2025.116272

Sanjana Balachandra, Rongzhi Wang, Ramsha Akhund, Ashba Allahwasaya, Brenessa Lindeman, Jessica Fazendin, Andrea Gillis, Herbert Chen

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引用次数: 0

Abstract

Introduction

Primary hyperparathyroidism (HPT) is typically characterized by elevated parathyroid hormone (PTH) and hypercalcemia; however, some patients develop normocalcemic hyperparathyroidism. Patients with normocalcemic HPT have an elevated PTH with normal calcium levels and no other secondary causes of elevated PTH, and therefore have a unique biochemical profile. The aim of this project is to compare the demographics, presentation, and outcomes for patients with normocalcemic HPT versus patients with hypercalcemic HPT undergoing parathyroidectomy.

Methods

A single institution, retrospective review was conducted between January 2016 and June 2022. Patients were classified as either having hypercalcemic (calcium >10.4 mg/dL) or normocalcemic (calcium ≤10.4 mg/dL) HPT. Cure was defined as normal calcium for 6 months post-operatively in the hypercalcemic HPT group and normal PTH (<88 pg/mL) for 6 months post-operatively in the normocalcemic HPT group.

Results

Of the 701 patients included in the study, 566 (80.7 %) had hypercalcemic HPT and 135 (19.3 %) had normocalcemic HPT. The preoperative Ca was 11 ± 0.7 mg/dL in the hypercalcemic group and 9.8 ± 0.4 mg/dL in the normocalcemic group (p < 0.001). The preoperative PTH was 148.2 ± 180 pg/dL in the hypercalcemic group and 117.4 ± 105.3 pg/dL in the normocalcemic group (p = 0.06). The average age of normocalcemic patients was 56 ± 15 years, compared to 59 ± 15 years in the hypercalcemic group (p = 0.07). There was no significant difference in sex (p = 0.42). African American patients were more likely to present with hypercalcemic HPT (19.1 %) than with normocalcemic HPT (9.6 %, p = 0.01). Normocalcemic patients were more likely to report pre-operative symptoms of kidney stones compared to patients with hypercalcemia (53.3 % versus 30.4 %, p < 0.001). There was no significant difference in pre-operative symptoms of fatigue, bone pain, or fractures. Patients with hypercalcemic HPT were more likely to present with adenoma (64.3 %); whereas patients with normocalcemic HPT were more likely to present with hyperplasia (43.3 %, p < 0.001). More patients with normocalcemic HPT underwent thymectomy compared to patients with hypercalcemia (39.3 % versus 20.8 % respectively, p < 0.001). 92.0 % of normocalcemic patients achieved cure post-operatively, which was significantly less than in the hypercalcemic group (97.0 %, p = 0.02). The 8.0 % of normocalcemic patients that did not achieve cure had a mean PTH level of 147.9 ± 159 pg/mL at 6 months post-operative. Four patients with normocalcemic HPT had recurrence of disease (3 %), and three of the four patients underwent bilateral exploration.

Conclusions

Patients with normocalcemic HPT present with different symptoms compared to patients with hypercalcemic HPT prior to surgery. Additionally, patients with normocalcemic HPT are less likely to achieve cure after surgery, which warrants further investigation.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.