[Primary hyperparathyroidism--changes in the disease picture]

Two groups of patients with primary hyperparathyroidism, one early group surgically treated operated between 1970 and 1979 (n = 90), and the other late group from 1980 to 1984 were compared concerning signs, symptoms and laboratory parameters in order to find out the changing trends in the clinical spectrum of this disease during these years. The decade of manifestation decreased from the age of sixty to fifty. The most common mode of presentation in the early group were renal (30%), gastrointestinal (27%), and osseous (18%) symptoms of primary hyperparathyroidism, and 21% symptoms due to hypercalcemia. In the later series severity of the typical symptoms decreased, diagnosis was made in nearly half of the patients (47%) by the incidental finding of hypercalcemia on routine biochemical screening. Careful investigation revealed that the severity but not the occurrence of organic and functional manifestations differed between the two groups. Mean serum calcium level decreased from 3.4 mmol/l in the early group to 3.1 mmol/l in the recent series. Parathyroid hormone level was increased in 90% respectively 79% of the patients. The localization of the parathyroids was done in 58% by ultrasound in the late group. Diagnosis was clearly made in 60% of the recent group by the combination of elevated serum calcium and parathyroid hormone levels and two associated symptoms. Diagnosis was more difficult in 10% when serum calcium was elevated and only one symptom was present. There is a trend in symptoms of primary hyperparathyroidism from typical "disease of stones, bones and abdominal groans" to a mild and nearly asymptomatic presentation detected by routine calcium screening.