Non-classical primary hyperparathyroidism at the Endocrinology Clinic of Târgu-Mureş between 2005 and 2010

Written by Kun Imre Zoltán, Szántó Zsuzsanna, Fazakas Gabriella, Balázs József

Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases. However, it is often diagnosed relatively late. The differentiation from other etiopathogenetic forms is sometimes difficult, thus creating some doubtfulness in choosing the adequate therapy. We proposed to study the clinical and laboratory/imagistic particularities, as well as the practical aspects of differential diagnosis and treatment in pHPT. The results of 18 pHPTs included in the study were compared to the data of 25 secondary and 10 tertiary HPTs. Most pHPTs (83.3%) were overt forms at diagnosis, usually more organs and systems being affected (nervous and osseous systems each in 86%, cardiovascular 73%, digestive and urinary apparatus each in 40%). The remained 16.6% were asymptomatic forms, these being detected accidentally. High parathyroid hormone level was associated with the classical laboratory modifi¬cations (hypercalcemia and hypophosphatemia) only in 50%, the other half having normocalcemia with normophosphatemia, or – rarely – hypercalcemia with normo¬phos¬phatemia or normocalcemia with hypophosphatemia. Imagistic investigations (sestaMIBI scinti¬gra¬phy of parathyroid glands, cervical and mediastinal CT/MRI) have identified before surgery the parathyroid lesion in 66% of patients. Parathyroid lesion(s) could be localized in 72.2% of pHPT (solitary adenoma in 33.3%, multiple adenomas and ectopic adenomas each in 16.7%, and hyperplasia in 5.5% of the patients), while the lesion is not yet identified in the rest (27.8%). The final treatment is surgery, being sometimes followed by severe hypocalcemia.


Keywords: overt and asymptomatic primary hyperparathyroidism, normocalcemic primary hyperparathyroidism

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