The Role of Gender in Primary Hyperparathyroidism: Same Disease, Different Presentation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
We analyzed a prospective database of 1309 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution between March 2001 and August 2010.
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.
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.
- Felix M. Therapeutischer versuch bein einem falls von otitis fibrosa generalisata mittles. Exstirpation eines epithelkorperchentumors. Wien Klin Wochenschr Zentral. 1926;53:260–4.
- Cope O. The study of hyperparathyroidism at the Massachusetts General Hospital. N Engl J Med. 1966;274:1174–82. CrossRef
- Fraser WD. Hyperparathyroidism. Lancet. 2009;374:145–58. CrossRef
- Miller BS, Dimick J, Wainess R, Burney RE. Age- and sex-related incidence of surgically treated primary hyperparathyroidism. World J Surg. 2008;32:795–9. CrossRef
- Melton LJ 3rd. The epidemiology of primary hyperparathyroidism in North America. J Bone Miner Res. 2002;17(Suppl 2):N12–7.
- Rude RK. Hyperparathyroidism. Otolaryngol Clin North Am. 1996;29:663–79.
- Caron NR, Pasieka JL. What symptom improvement can be expected after operation for primary hyperparathyroidism? World J Surg. 2009;33:2244–55. CrossRef
- Kelly KJ, Chen H, Sippel RS. Primary hyperparathyroidism. Cancer Treat Res. 2010;153:87–103. CrossRef
- Bilezikian JP, Khan AA, Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Third International Workshop. J Clin Endocrinol Metab. 2009;94:335–9. CrossRef
- Adler JT, Sippel RS, Schaefer S, Chen H. Surgery improves quality of life in patients with “mild” hyperparathyroidism. Am J Surg. 2009;197:284–90. CrossRef
- Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–7. CrossRef
- Sneider MS, Solorzano CC, Montano RE, Anello C, Irvin GL 3rd, Lew JI. Sporadic primary hyperparathyroidism in young individuals: different disease and treatment? J Surg Res. 2009;155:100–3. CrossRef
- Kandil E, Tsai HL, Somervell H, et al. African Americans present with more severe primary hyperparathyroidism than non–African Americans. Surgery. 2008;144:1023–6. CrossRef
- Barker H, Caldwell L, Lovato J, Woods KF, Perrier ND. Is there a racial difference in presentation of primary hyperparathyroidism? Am Surg. 2004;70:504–6.
- Ballem N, Greene AB, Parikh RT, Berber E, Siperstein A, Milas M. Appreciation of osteoporosis among men with hyperparathyroidism. Endocr Pract. 2008;14:820–31.
- Richert L, Trombetti A, Herrmann FR, et al. Age and gender distribution of primary hyperparathyroidism and incidence of surgical treatment in a European country with a particularly high life expectancy. Swiss Med Wkly. 2009;139:400–4.
- Hughes P. The CARI guidelines. Kidney stones epidemiology. Nephrology (Carlton). 2007;12(Suppl 1):S26–30. CrossRef
- Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116:c159–71. CrossRef
- Worcester EM, Coe FL. Clinical practice. Calcium kidney stones. N Engl J Med. 2010;363:954–63. CrossRef
- Jordan KM, Cooper C. Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol. 2002;16:795–806. CrossRef
- Moretz WH 3rd, Watts TL, Virgin FW Jr, Chin E, Gourin CG, Terris DJ. Correlation of intraoperative parathyroid hormone levels with parathyroid gland size. Laryngoscope. 2007;117:1957–60. CrossRef
- Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006;141:777–82. CrossRef
- Khan AA, Bilezikian JP, Potts JT Jr. The diagnosis and management of asymptomatic primary hyperparathyroidism revisited. J Clin Endocrinol Metab. 2009;94:333–4. CrossRef
- The Role of Gender in Primary Hyperparathyroidism: Same Disease, Different Presentation
Annals of Surgical Oncology
Volume 19, Issue 9 , pp 2958-2962
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors