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Thiazide-Associated Hypercalcemia: Incidence and Association With Primary Hyperparathyroidism Over Two Decades
Marcio L Griebeler1, Ann E Kearns1, Euijung Ryu1
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117.
Thiazide diuretics can cause hypercalcemia, often linked to underlying primary hyperparathyroidism. Increased incidence since 1998 may stem from enhanced osteoporosis screening.
Area of Science:
- Endocrinology
- Nephrology
- Epidemiology
Background:
- Thiazide diuretics are widely prescribed antihypertensives.
- Hypercalcemia is a known side effect, but its epidemiology is unclear.
Purpose of the Study:
- To determine the incidence of thiazide-associated hypercalcemia.
- To describe the clinical features of this condition.
Main Methods:
- Population-based descriptive study in Olmsted County, Minnesota (1992-2010).
- Utilized Rochester Epidemiology Project and Mayo Clinic Laboratory Information System for case identification.
Main Results:
- Identified 221 cases of thiazide-associated hypercalcemia.
- Incidence rose significantly after 1997, peaking in 2006.
- Primary hyperparathyroidism diagnosed in 24% of patients.
Conclusions:
- Many thiazide-associated hypercalcemia cases involve primary hyperparathyroidism.
- Rising incidence may be due to case ascertainment bias from osteoporosis screening.
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