Olga A Lavryk1, Allan E Siperstein2. 1. Endocrine Surgery Department, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Endocrine Surgery Department, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. sipersa@ccf.org.
Abstract
BACKGROUND: The diagnosis of primary hyperparathyroidism (1°HP) has become more complex, as fewer patients present with classic phenotype of concomitant elevation of calcium and parathyroid hormone (PTH). In addition, the distinction between normal versus abnormal patients is challenging, with an increasing number of patients with 1°HP, who have calcium and/or PTH values within the "reference" range. Patients with "inappropriately" elevated PTH values relative to their serum calcium are considered to have 1°HP. METHODS: The study population consisted of 1753 patients with pathologically proven 1°HP and 74 healthy control patients. Nomograms were created by plotting PTH versus calcium of the two groups. The 95 % confidence zone of calcium and PTH for normal individuals was plotted and compared to patients with 1°HP. RESULTS: The comparison of control and disease groups showed a clear demarcation zone on the plots of calcium versus PTH. In the group of 1°HP, 70 % had classic 1°HP presentation with the concomitant elevation of both calcium (≥10.5 mg/dL) and PTH (≥65 pg/dL). 21 % had "normocalcemic" HP with calcium ≤10.5 mg/dL and PTH ≥65 pg/dL. 6 % had "normohormonal" HP with calcium ≥10.5 mg/dL and PTH ≤65 pg/dL. 3 % had both calcium and PTH within the reference range. 68.5 % of patients had single adenoma, 16 % double adenoma, and 15.5 % hyperplasia. CONCLUSION: This nomogram serves as a diagnostic tool to distinguish normal patients from those with 1°HP, particularly those with atypical presentations. This recognition would permit previously observed patients to benefit from curative surgery.
BACKGROUND: The diagnosis of primary hyperparathyroidism (1°HP) has become more complex, as fewer patients present with classic phenotype of concomitant elevation of calcium and parathyroid hormone (PTH). In addition, the distinction between normal versus abnormal patients is challenging, with an increasing number of patients with 1°HP, who have calcium and/or PTH values within the "reference" range. Patients with "inappropriately" elevated PTH values relative to their serum calcium are considered to have 1°HP. METHODS: The study population consisted of 1753 patients with pathologically proven 1°HP and 74 healthy control patients. Nomograms were created by plotting PTH versus calcium of the two groups. The 95 % confidence zone of calcium and PTH for normal individuals was plotted and compared to patients with 1°HP. RESULTS: The comparison of control and disease groups showed a clear demarcation zone on the plots of calcium versus PTH. In the group of 1°HP, 70 % had classic 1°HP presentation with the concomitant elevation of both calcium (≥10.5 mg/dL) and PTH (≥65 pg/dL). 21 % had "normocalcemic" HP with calcium ≤10.5 mg/dL and PTH ≥65 pg/dL. 6 % had "normohormonal" HP with calcium ≥10.5 mg/dL and PTH ≤65 pg/dL. 3 % had both calcium and PTH within the reference range. 68.5 % of patients had single adenoma, 16 % double adenoma, and 15.5 % hyperplasia. CONCLUSION: This nomogram serves as a diagnostic tool to distinguish normal patients from those with 1°HP, particularly those with atypical presentations. This recognition would permit previously observed patients to benefit from curative surgery.
Authors: Martin Almquist; Anders Bergenfelz; Hans Mårtensson; Mark Thier; Erik Nordenström Journal: Langenbecks Arch Surg Date: 2010-07-10 Impact factor: 3.445
Authors: Danielle M Press; Allan E Siperstein; Eren Berber; Joyce J Shin; Rosemarie Metzger; Rosebel Monteiro; Jeff Mino; Warren Swagel; Jamie C Mitchell Journal: Surgery Date: 2013-12 Impact factor: 3.982
Authors: Allan Siperstein; Eren Berber; German F Barbosa; Michael Tsinberg; Andrew B Greene; Jamie Mitchell; Mira Milas Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: Russel Krawitz; Anthony Glover; Sireesha Koneru; James Jiang; Aimee Di Marco; Anthony J Gill; Ahmad Aniss; Mark Sywak; Leigh Delbridge; Stan Sidhu Journal: World J Surg Date: 2020-04 Impact factor: 3.352
Authors: Hye Ryeon Choi; Sun Hyung Choi; Namki Hong; Yumie Rhee; Jin Kyong Kim; Cho Rok Lee; Sang-Wook Kang; Jandee Lee; Jong Ju Jeong; Kee-Hyun Nam; Woong Youn Chung Journal: J Korean Med Sci Date: 2022-04-04 Impact factor: 2.153