The changing presentation of hyperparathyroidism over 3 decades

Area of Science:

• Endocrinology
• Surgical Oncology
• Metabolic Bone Disease

Background:

• Primary hyperparathyroidism (PHP) is a common endocrine disorder.
• The clinical presentation and referral patterns for PHP have evolved over time.
• Understanding these changes is crucial for timely diagnosis and management.

Purpose of the Study:

• To analyze the changes in the clinical presentation of primary hyperparathyroidism over the past three decades.
• To identify shifts in patient demographics, biochemical markers, and reasons for surgical referral.
• To assess the impact of increased awareness and screening on PHP patient profiles.

Main Methods:

• Retrospective review of 300 patients undergoing parathyroidectomy for PHP.
• Patients were analyzed from three distinct time periods: 1985, 1995, and 2005 (100 patients each).
• Data analyzed included age, sex, preoperative calcium levels, duration of hypercalcemia, presenting symptoms, and referral indications.

Main Results:

• Mean preoperative calcium levels decreased significantly from 11.8 mg/dL in 1985 to 11.2 mg/dL in 2005.
• The proportion of patients with calcium < 11.0 mg/dL rose from 10% to 43% over the study period.
• Referral for osteoporosis increased, with 44% of patients diagnosed with osteoporosis or osteopenia by 2005, up from 10% in 1985.

Conclusions:

• Increased awareness of PHP and its skeletal consequences, along with bone densitometry screening, has altered patient profiles.
• Patients are now referred for surgery earlier, with less severe hypercalcemia.
• There is a greater recognition of associated osteoporosis in patients with PHP.