Primary Hyperparathyroidism, with a Focus on Management of the Normocalcemic Form. To Treat or not to Treat?
| Authors | |
|---|---|
| Year of publication | 2016 |
| Type | Article in Periodical |
| Magazine / Source | Endocrine Practice |
| MU Faculty or unit | |
| Citation | |
| Doi | http://dx.doi.org/10.4158/EP15704.OR |
| Field | Endocrinology, diabetology, metabolism, nutrition |
| Keywords | hyperparathyroidism; NCPHPT |
| Description | OBJECTIVE: The aim of this study was to determine reasonable care for NCPHPT patients treated at the Endocrine Clinic. METHODS: The study is based on 218 outpatient cases of primary hyperparathyroidism (PHPT), 187 (86%) of whom were NCPHPT. Subjective complaints, biochemical tests, imaging and treatment outcome for NCPHPT patients were monitored and compared with the same parameters in patients with hypercalcemic hyperparathyroidism (HCPHPT). The number of patients with newly diagnosed NCPHPT who became hypercalcemic and the time period in which it happened were also recorded. RESULTS: Over 6 years of study, in total, 36/187 originally normocalcemic patients became hypercalcemic (19%); 24/36 within 2 years and 2/36 later than after 4 years. MIBI scintigraphy was performed in 103 normocalcemic patients (adenoma was detected in 5 cases) and in 46 hypercalcemic patients with pathologically elevated serum calcium levels of at the time of assesment (adenoma was detected in 32/46 cases). Surgery was performed in 33 patients, 11 of whom were originally normocalcemic (i.e. 6% of all 187 originally normocalcemic patients) and 22 were hypercalcemic from the outset (i.e. 71% of all 31 originally hypercalcemic patients). CONCLUSIONS: Some NCPHPT patients converted to hypercalcemic, mostly within 2 years but some after 4 years or later. Normocalcemic patients should be monitored on long-term basis as it is impossible to anticipate when and which normocalcemic patients will become hypercalcemic. Imaging is much less effective in normocalcemic than in hypercalcemic patients. |