An update from the latest workshop on asymptomatic primary hyperparathyroidism

Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK

“…The data and methods we used have three strengths compared with other epidemiological studies: first, our routine collected and collated data provided us with a robust population database of biochemical tests. PHPT diagnoses were made when hypercalcaemia coexists with inappropriate normal or elevated PTH concentration from an unselected population 1,2,9,29 . The accuracy of our biochemical algorithm is greater than 95%, and the total agreement between case notes and electronic identification reached 99·4%, indicating that this is a reliable resource to identify patients.…”

“…For such patients, PTH concentrations (normal range 2–6·9 pmol/l) and urine calcium and creatinine records were observed. PHPT was diagnosed when persistent hypercalcaemia occurred with the presence of elevated or inappropriately normal PTH levels 2,28,29 . Therefore, if a patient met one of the following criteria, an initial‐biochemistry‐based, probable diagnosis of PHPT was made:…”

“…Additionally, urine biochemistry was used to confirm definite diagnoses, when either of the following criteria was met: increased urine calcium excretion as measured on a spot urine sample (the ratio of the clearance of calcium to the clearance of creatinine > 0·03 in presence of hypercalcaemia), or a 24 h urinary calcium excretion > 7 mmol/day. The urinary criteria were also used to exclude possible familial hypocalciuric hypercalcaemia (FHH) patients 2,14 . Among the remaining probable cases, tertiary hyperparathyroid cases were identified and excluded if persistently elevated serum creatinine (> 250 mmol/l) was observed prior to the first raised serum calcium.…”

“…Primary hyperparathyroidism (PHPT) is a common endocrine disorder whose clinical profile has changed dramatically over the last three decades with the increasing accessibility to routine biochemical screenings. The traditional manifestation of PHPT classically described as ‘stones, bones, abdominal groans and psychic moans’ has moved towards a more subtle asymptomatic form 1–10 . The proportion of asymptomatic patients among all patients increased from 18% in early 1960s to over 80% nowadays 11–13 …”

What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS)

“…The reason for this is that patients fitting the NIH criteria for surgery are thought to be at greatest risk of adverse outcomes. As some long‐term studies of the natural history of PHPT have shown that the majority of untreated patients do not progress over time, patients with mild hypercalcaemia are considered as being safely monitored without surgery . However, we have previously demonstrated that patients with PHPT and mild hypercalcaemia have increased risk of developing adverse complications, including mortality, compared with the general population.…”