Revealing the sex divide: Primary hyperparathyroidism across the American population

Sex-based differences in the presentation of primary hyperparathyroidism (PHPT) remain poorly understood. A comprehensive understanding of how PHPT manifests and progresses in male versus female patients in the U.S. is still lacking. This study aims to evaluate sex-based differences in the preoperative presentation and postoperative outcomes of patients undergoing parathyroidectomy (PTX).

A multi-institutional research network, comprising data from 58 U S. institutions, was retrospectively queried for patients presenting with PHPT (ICD-10 E21.0) and PTX (CPT 60500). The follow-up period was 3 ± 2 years. Cox regression analysis was employed to assess differences in pre-operative presentations and post-operative outcomes.

This study included 39,216 females and 11,101 males. Females presented with PHPT at an older age (62 ± 13 vs. 60 ± 14, p < 0.01). Males presented with higher levels of pre-operative calcium (10.8 ± 0.9 vs. 10.7 ± 0.8, p < 0.001) and parathyroid hormone (136 ± 151 vs. 125 ± 139, p < 0.001). Females were more likely to present with osteoporosis (26% vs. 11%, p < 0.001), fatigue (16% vs. 12%, p < 0.01), and vitamin D deficiency (29% vs. 24%, p < 0.001). In comparison, males were more likely to present preoperatively with chronic kidney disease (11% vs. 8%, p < 0.001) and nephrolithiasis (21% vs. 13%, p < 0.001). No significant differences were observed in re-operation rates or recurrent laryngeal nerve injury.

Females make up most cases of PHPT and are more likely to experience musculoskeletal disorders and fatigue, while males are more prone to renal complications. These sex-based differences in clinical presentation underscore the importance of timely surgical intervention.