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Symptomatic versus asymptomatic primary hyperparathyroidism: A systematic review and meta-analysis
Pallavi Kulkarni1, Jacqueline Tucker1, Tonya King2
1Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, PA, USA.
Journal of Clinical & Translational Endocrinology
|April 24, 2023
Summary
Primary hyperparathyroidism (PHPT) is often mislabeled as asymptomatic, as even these patients show clinical features. This systematic review suggests "asymptomatic" PHPT is a misnomer, highlighting the need for re-evaluation.
Area of Science:
- Endocrinology
- Metabolic Bone Disease
- Clinical Medicine
Background:
- Primary hyperparathyroidism (PHPT) accounts for 90% of hypercalcemia cases.
- PHPT is traditionally classified into symptomatic and asymptomatic groups.
- This classification may be inaccurate, as
- asymptomatic
- patients may present with clinical features.
Purpose of the Study:
- To systematically review and meta-analyze literature comparing symptomatic and asymptomatic PHPT.
- To elucidate the clinical and biochemical differences between these patient groups.
- To challenge the current terminology of
- asymptomatic
- PHPT.
Main Methods:
- Comprehensive literature search of PubMed, Cochrane, and Web of Science (2012-2022).
- Inclusion of studies comparing symptomatic and asymptomatic PHPT patients.
- Systematic review and meta-analysis following PRISMA guidelines, with heterogeneity assessment using I² index.
Main Results:
- 18 studies with 4238 patients were included.
- Symptomatic PHPT patients exhibited higher PTH and calcium levels, and lower vitamin D levels.
- Even
- asymptomatic
- patients displayed clinical features, indicating potential mislabeling.
Conclusions:
- Symptomatic PHPT is associated with more extreme biochemical markers (PTH, calcium) and lower vitamin D.
- The presence of clinical features in
- asymptomatic
- patients suggests this term is inappropriate.
- Re-evaluation of PHPT classification is warranted based on these findings.
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