A Timeline for Primary Hyperparathyroidism

Presentation Number: MON 342
Date of Presentation: April 3rd, 2017

Robert Naples*1, Allan E Siperstein2, Joyce J Shin1, Judy Jin1 and Eren Berber2
1Cleveland Clinic Foundation, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH

Abstract

It has been reported that patients live with primary hyperparathyroidism for years before diagnosis and surgery1, yet no study to date has revealed a timeline. We aimed to establish a timeline for primary hyperparathyroidism from first known calcium value to surgery. This study was a retrospective review of all patients undergoing parathyroidectomy in 2013 at the Cleveland Clinic. Patients with only primary hyperparathyroidism were included in the study. Subjects with primary hyperparathyroidism were divided into three groups: (1) overt primary hyperparathyroidism (PHP), (2) normocalcemic primary hyperparathyroidism (NCPHP), and (3) normohormonal primary hyperparathyroidism (NHPHP). Each subject was also stratified by age (<50, 50-70, >70), calcium values (10.6-11.0, 11.1-11.5, >11.5), and PTH values (<50, 50-65, 66-100, 101-150, >150) regardless of the group classification. There were 191 (70%) subjects who met criteria for PHP, 23 (8%) for NCPHP, and 61 (22%) for NHPHP. NHPHP had a mean delay between the first elevated calcium value and surgery of 4.5 years compared to 3.5 years for PHP (p = 0.0432), which was in part due to the difficulty in diagnosis of NHPHP. This was demonstrated by a mean delay between the first PTH value and diagnosis which was 29.7 months for NHPHP compared to 10.7 months for PHP (p = <0.0001). NCPHP showed the similar trend as NHPHP in terms of difficulty in diagnosis. The mean delay between the first PTH value and diagnosis for NCPHP was 23.0 months (p = <0.0001). Additionally, subjects with calcium values >11.5 mg/dL (p = <0.0001) and <50 years of age (p = 0.0026) had shorter time intervals to surgery. NHPHP and NCPHP take a longer time to diagnosis and, therefore, surgery. Further, patients that do not fit the guidelines from the Third International Workshop are forgotten about for surgical referral. More awareness of primary hyperparathyroidism and the biochemical profiles can expedite diagnosis and surgery.

 

Nothing to Disclose: RN, AES, JJS, JJ, EB