Normocalcemic Hyperparathyroidism: Bridging the Gap in Parathyroid Research

Area of Science:

• Endocrinology
• Neurosurgery
• Medical Informatics

Background:

• Normocalcemic primary hyperparathyroidism (ncPHPT) patients exhibit similar symptoms to classic PHPT.
• Large-scale analyses of ncPHPT are lacking.
• The TriNetX database enables study of ncPHPT trends in a large cohort.

Purpose of the Study:

• To characterize the diagnostic and treatment patterns for ncPHPT.
• To analyze treatment paradigms for ncPHPT in a large international database.

Main Methods:

• Retrospective cohort study using the TriNetX Research Network (52 healthcare organizations, 2007-2023).
• ncPHPT defined as PTH ≥66pg/mL and calcium 8.4-10.4 mg/dL.
• Exclusion of secondary, tertiary, and classic hyperparathyroidism, and other hypercalcemia causes.

Main Results:

• Identified 5092 ncPHPT patients (78.2% female, mean age 69±13 years, 78.9% White).
• Average serum calcium 9.7±0.5 mg/dL, average PTH 97±77.5 pg/mL.
• Only 40% (2036 patients) underwent parathyroidectomy; post-surgery PTH levels decreased significantly.

Conclusions:

• A minority of ncPHPT patients in this large cohort underwent parathyroidectomy.
• There is a need for enhanced provider education regarding the benefits of surgery for ncPHPT.