The role of gender in primary hyperparathyroidism: same disease, different presentation.

BACKGROUND: Hyperparathyroidism is much more common in women and therefore may represent different diseases in men and women. In order to understand the role of gender in hyperparathyroidism, we reviewed our experience.
METHODS: We analyzed a prospective database of 1309 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution between March 2001 and August 2010.
RESULTS: The female-to-male ratio was 3.3:1, and female patients were older at presentation (60 ± 0 vs. 57 ± 1 years, p < 0.005). Male patients were more commonly asymptomatic at presentation (25 % vs. 18 %, p = 0.005) and the most common symptom for men was kidney stones (23 % vs. 13 %, p < 0.0001). For patients with bone density scans, osteoporosis was more common in women (34 % vs. 17 %, p < 0.0001). Men had a slightly higher preoperative serum calcium level (11.1 ± 0 vs. 11.0 ± 0 mg/dl, p = 0.03), higher parathyroid hormone level (140 ± 7 vs. 124 ± 4 pg/ml, p = 0.04), higher urinary calcium level (376 ± 10 vs. 314 ± 5 mg/24 h, p < 0.005), and lower vitamin D level (28 ± 1 vs. 32 ± 0 ng/ml, p < 0.005). Men were more likely to have abnormally elevated creatinine values (15 % vs. 9 %, p = 0.004). The operative approach as well as the number of glands involved and their location did not significantly differ between the groups. The mean gland weight for a single adenomas was higher in male patients (1123 ± 128 vs. 636 ± 32 mg, p = 0.001). No significant difference was identified in the immediate and remote postoperative course.
CONCLUSIONS: Hyperparathyroidism appears to present differently depending on gender. Male patients more often present without symptoms, present with vitamin D deficiency, and have larger parathyroid glands. Importantly, surgical outcomes were equivalent between men and women.