Gender difference in clinical presentation of primary hyperparathyroidism

Abstract Background The clinical presentation of primary hyperparathyroidism (PHPT) has changed greatly during the past few decades. Our aim was to evaluate whether the clinical presentation at diagnosis differed according to age. Methods We evaluated retrospectively a monocentric series of 462 consecutive patients with PHPT, dividing them according to a cutoff of 65 years of age. Results No differences were found in the mean serum PTH, calcium, or vitamin D levels. In older patients (n = 212; 45.9%), the urinary calcium levels were significantly lower (median, 205 mg/24 hour; interquartile range, 220 mg/24 hour) compared with those in younger patients (median, 308 mg/24 hour; interquartile range, 233 mg/24 hour). In addition, renal involvement was significantly less frequent (25% vs 49.2%), and bone involvement significantly more frequent (58% vs 44%) in older patients compared with younger patients. The clinical presentation was significantly different between the two age groups, with a lower frequency of symptomatic forms and a greater frequency of asymptomatic forms not meeting surgical criteria in the older patients (44.4% vs 57.2% and 18.4% vs 5.6%, respectively). Osteoporosis was significantly more frequent in the older adults than in their younger counterparts. The most affected bone site was the forearm in older adults and the lumbar spine in younger ones (50.3% and 50.5%, respectively). Conclusion The clinical presentation of PHPT differs according to age, and this difference can affect the selection of management modalities.

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Severe Hypercalcemia due to Primary Hyperparathyroidism with MEN 2A

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1037 ◽

2010 ◽

Vol 2 (3) ◽

pp. 131-133

Author(s):

Geoffrey B Thompson ◽

Benzon M Dy ◽

Bianca Vazquez ◽

Peter J Tebben ◽

Seema Kumar

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Surgical Management ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Mineral Density ◽

Normal Range ◽

Rare Presentation ◽

Severe Hypercalcemia ◽

Men 2A

ABSTRACT Introduction Severe hypercalcemia due to primary hyperparathyroidism (PHPT) is rare in the setting of MEN 2A. Materials and methods Two patients with MEN 2A and severe hypercalcemia were identified recently. Their clinical presentation, evaluation, surgical management and outcomes are reviewed. Results Two patients with MEN 2A were identified with severe hypercalcemia secondary to a parathyroid adenoma. Calcium levels were elevated to 12.7 mg/dL and 15.1 mg/dL, respectively (normal range = 8.9-10.1 mg/dL). In each case, a single parathyroid adenoma was identified and surgically excised with normalization of parathyroid and calcium levels postoperatively. Clinical manifestations at the time of diagnosis included constipation, polyuria, hypercalciuria, and decreased bone mineral density. Conclusion Severe elevation of serum calcium is a rare presentation of PHPT in MEN2A. The differential diagnosis should include parathyroid adenoma, hyperplasia and parathyroid carcinoma. Early surgical management is essential in the treatment of hyperparathyroidism with severe hypercalcemia to prevent further complications.

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Clinical presentation and management of patients with primary hyperparathyroidism of the Swiss Primary Hyperparathyroidism Cohort: a focus on neuro-behavioral and cognitive symptoms

Journal of Endocrinological Investigation ◽

10.1007/s40618-015-0423-3 ◽

2016 ◽

Vol 39 (5) ◽

pp. 567-576 ◽

Cited By ~ 11

Author(s):

A. Trombetti ◽

E. R. Christ ◽

C. Henzen ◽

G. Gold ◽

M. Brändle ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Clinical Presentation ◽

Cognitive Symptoms

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SAT-LB65 A Rare Existence

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1998 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jiselle Aimee Yaplito Bedia ◽

Maria Honolina S Gomez

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Clinical Presentation ◽

Renal Involvement ◽

Preoperative Imaging ◽

Biochemical Screening ◽

Central Target ◽

Target Organs ◽

Postoperative Hypoparathyroidism ◽

Parathyroid Adenomas

Abstract Primary hyperparathyroidism is a common endocrine disorder of metabolism usually due to a parathyroid adenoma. Although, the clinical presentation of primary hyperparathyroidism has changed from Albright’s description of a disease of bones and stones, the central target organs affected by this disorder continue to be the skeleton and kidneys. With the advent of routine biochemical screening, the typical diagnosis of primary hyperparathyroidism is no longer accompanied by overt skeletal and renal involvement. Majority of the cases of primary hyperparathyroidism are due to parathyroid adenomas. Giant glands were defined as greater than the 95th percentile, characterized as glands weighing > 3.5 grams. This present case in a 54-year old female is a rare case of primary hyperparathyroidism secondary to a giant parathyroid adenoma measuring 10.7 x 8.0 x 40.0 cm and weighing 145 grams, the largest giant parathyroid adenoma reported to date, with co-existent silent thymoma, multinodular goiter and osteosclerosis of the vertebral spine, metaphorically known as the “rugger-jersey spine”. The association between thymoma and parathyroid adenoma is rare, and only 3 cases have been reported in the literature. We characterized the correlation of preoperative imaging, intraoperative location, and postoperative course, including significant postoperative hypoparathyroidism, as compared to other patients with PHPT to determine whether giant adenomas represent a clinical entity with distinct clinical characteristics. Keywords: primary hyperparathyroidism, giant parathyroid adenoma, rugger-jersey spine, thymoma Abbreviation PHPT Primary hyperparathyroidism

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Clinical Presentation of Primary Hyperparathyroidism

The Parathyroids ◽

10.1016/b978-012098651-4/50024-9 ◽

2001 ◽

pp. 375-xiii ◽

Cited By ~ 14

Author(s):

AMBRISH MITHAL ◽

FRANCISCO BANDEIRA ◽

XUNWU MENG ◽

SHONNI J. SILVERBERG ◽

YIFAN SHI ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Clinical Presentation

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Trabecular bone mineral density in primary hyperparathyroidism: relationship to clinical presentation and biomarkers of skeletal turnover

Bone and Mineral ◽

10.1016/s0169-6009(08)80020-7 ◽

1993 ◽

Vol 20 (2) ◽

pp. 113-123 ◽

Cited By ~ 27

Author(s):

S. Minisola ◽

R. Rosso ◽

E. Romagnoli ◽

M.T. Pacitti ◽

L. Scarnecchia ◽

...

Keyword(s):

Bone Mineral Density ◽

Primary Hyperparathyroidism ◽

Trabecular Bone ◽

Bone Mineral ◽

Clinical Presentation ◽

Mineral Density ◽

Trabecular Bone Mineral Density

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Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Italian Journal of Medicine ◽

10.4081/itjm.2015.547 ◽

2015 ◽

Vol 9 (4) ◽

pp. 330

Author(s):

Andrea Percivale ◽

Paola Gnerre ◽

Giulio Damonte ◽

Sandra Buscaglia ◽

Mario Monachesi ◽

...

Keyword(s):

Parathyroid Hormone ◽

Surgical Treatment ◽

Primary Hyperparathyroidism ◽

Clinical Presentation ◽

Definitive Treatment ◽

Diagnostic Tools ◽

Current Management ◽

Knowledge Based ◽

Relevant Role

Primary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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