Characteristics of patients surgically treated for primary hyperparathyroidism with and without renal stones

Between 1980 and 1984, 312 (30%) of 1038 patients undergoing initial cervical exploration for primary hyperparathyroidism (pHPT) at our institution had proven renal stones.

In this retrospective study we focused on clinical characteristics, biochemical tests, perioperative and pathologic findings, and immediate outcomes of operation, comparing findings in patients with and without renal stones.

Patients with renal stones were more often younger male patients, had serum phosphorus levels significantly lower (p < 0.02) and 24-hour urinary calcium excretion significantly higher (p < 0.0001) than patients without renal stones, and had a significantly higher (p < 0.05) proportion of abnormal glands weighing less than 250 mg. Relevant diagnostic preoperative variables were evaluated by means of multivariate analysis to determine whether they independently had predictive power with regard to renal stones. Male gender and younger age were significantly associated with the presence of renal stones, providing odds ratios of 2.5 and 1.4, respectively. In addition, the risk of having renal stones was significantly related to minimally elevated serum calcium levels (p < 0.05), serum phosphorus levels (p = 0.02), and 24-hour urine calcium excretion (p < 0.05).

In patients with renal stones the diagnosis of pHPT should be considered. If the diagnosis is confirmed, a liberal approach to cervical exploration should be taken.