FACTORS ASSOCIATED WITH SEVERE HYPERCALCEMIA IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

Abstract

Objectives: To determine the factors associated with severe hypercalcemia (SH) in primary hyperparathyroidism (PHPT). Methods: This is a retrospective study involving the medical records of 123 patients with PHPT collected over a period of 20 years. The patients were subdivided into two groups according to their highest calcium level: ≥ 3.25 mmol/l (SH) or < 3.25 mmol/l (Moderate hypercalcemia). The two groups were compared by univariate and multivariate analysis according to their socio-demographic, clinical and paraclinical parameters. Results: The prevalence of SH was 35.8%. Clinical factors associated with SH were abdominal pain (p=0.02), vomiting (p=0.05), and acute pancreatitis (p=0.005). Biological factors associated with SH were higher PTH level (p=0.001) and vitamin D deficiency (p=0.01). The parathyroid adenoma size was significantly higher and parathyroid carcinoma was more frequent in the SH group (p=0.001 and p=0.06, respectively). After multivariate analysis, the factors independently associated with SH were a parathyroid adenoma size ≥20 mm and a PTH level ≥300 pg /ml (adjusted odds ratios = 12 and 7.7 respectively). Conclusion: In patients with PHPT, a PTH level ≥300 pg/ml and a parathyroid adenoma size ≥20 mm are the main predictors of the onset of SH. Acute pancreatitis and parathyroid carcinoma appear to be more common in these forms of PHPT, requiring prompt surgical management after medical preparation.