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Classic Primary Hyperparathyroidism Versus Normocalcemic and Normohormonal Variants: Do They Really Differ?
Andreas Kiriakopoulos1, Athanasios Petralias2, Dimitrios Linos3
1Department of Surgery, 5th Surgical Clinic, Evgenidion Hospital, National and Kapodistrian University of Athens Medical School, Papadiamantopoulou 20 Str., 11528, Athens, Greece. andykirian@gmail.com.
World Journal of Surgery
|February 3, 2018
Summary
Normocalcemic primary hyperparathyroidism (NCpHPT) is similar to classic pHPT but presents diagnostic challenges. NCpHPT is linked to smaller adenoma weight and reduced ultrasound accuracy compared to other variants.
Area of Science:
- Endocrinology
- Surgical Pathology
- Medical Diagnostics
Background:
- Primary hyperparathyroidism (pHPT) encompasses distinct variants, including normocalcemic (NCpHPT) and normohormonal (NHpHPT) forms.
- These variants present diagnostic and management challenges, necessitating a clearer understanding of their differences.
- Surgical treatment outcomes provide valuable insights into the clinical characteristics of these pHPT subtypes.
Purpose of the Study:
- To delineate the distinguishing features between normocalcemic primary hyperparathyroidism (NCpHPT) and classic hypercalcemic primary hyperparathyroidism (CpHPT).
- To compare the clinical presentation and diagnostic findings in patients with NCpHPT, NHpHPT, and CpHPT.
- To evaluate the surgical outcomes and diagnostic test performance across different pHPT variants.
Main Methods:
- A cohort of 149 surgically treated patients were categorized into CpHPT, NCpHPT, and NHpHPT groups (2011-2015).
- Clinical data, including serum calcium and parathyroid hormone levels, were analyzed.
- Multivariate logistic and linear regression analyses were employed to identify significant inter-group differences, including adenoma weight and diagnostic imaging utility.
Main Results:
- NCpHPT patients exhibited significantly smaller parathyroid adenoma weights compared to other groups (p=0.023).
- Ultrasound (U/S) demonstrated a lower positive predictive value and reduced concordance with MIBI scans in NCpHPT cases.
- While a trend for higher multiglandular disease (MGD) was noted in NCpHPT, it did not reach statistical significance.
Conclusions:
- Normocalcemic primary hyperparathyroidism (NCpHPT) shares similarities with classic pHPT but presents unique challenges.
- NCpHPT is associated with smaller adenoma size and decreased diagnostic accuracy of U/S and MIBI concordance.
- Further research may clarify the role of MGD in NCpHPT and optimize diagnostic strategies.
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