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Hyperparathyroidism: cause or consequence of recurrent calcium nephrolithiasis?
A D'Angelo1, M G Lodetti, S Giannini
1Institute of Internal Medicine, University of Padova, Italy.
Mineral and Electrolyte Metabolism
|January 1, 1992
Summary
Primary hyperparathyroidism (PHP) presents distinct bone and kidney stone patterns. While vitamin D levels didn't differ, parathyroid hyperplasia in stone formers suggests it may follow, not cause, kidney stones.
Area of Science:
- Endocrinology
- Nephrology
- Metabolic Bone Disease
Background:
- Primary hyperparathyroidism (PHP) exhibits diverse clinical presentations, including bone disease and nephrolithiasis.
- Metabolic and hormonal differences may underlie these distinct patterns.
Purpose of the Study:
- To investigate potential hormonal and metabolic distinctions between PHP patients with and without kidney stones.
- To explore the relationship between parathyroid gland histology and clinical presentation.
Main Methods:
- Studied 129 patients with PHP, categorized into 95 stone formers (SF) and 34 non-stone formers (NSF).
- Assessed serum calcium, urinary calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels.
- Examined parathyroid gland histology.
Main Results:
- NSF patients showed more severe bone lesions compared to SF.
- Parathyroid adenoma was more common in NSF, while hyperplasia predominated in SF.
- SF had lower serum calcium, urinary calcium, ALP, and PTH levels than NSF.
- Serum 1,25-dihydroxyvitamin D levels were elevated in both groups but did not differ between SF and NSF.
Conclusions:
- PHP patients can represent distinct metabolic and clinical entities.
- Serum 1,25-dihydroxyvitamin D does not appear to be a key differentiator between clinical phenotypes.
- Parathyroid hyperplasia in SF and recurrent hyperparathyroidism suggest nephrolithiasis might precede or cause PHP in some cases.