Skip to main content
SpringerLink
Log in

The importance of hypophosphatemia in the clinical management of primary hyperparathyroidism

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Aim

The levels of serum phosphorus (P) are low or low-normal in primary hyperparathyroidism (PHPT), and there is an inverse relationship between the levels of parathormone (PTH) and P. However, when considering the diagnostic and surgical indication criteria of PHPT, serum P levels are generally ignored. The aim of this study was to retrospectively evaluate the association of serum P levels with the clinical outcomes of PHPT.

Materials and Methods

A retrospective evaluation was made of the data of 424 consecutive patients (370 females, 54 males) with PHPT who presented at our centre.

Results

The mean age of the study population was 57 ± 11.68 years. The mean P was 2.57 ± 0.53 mg/dl. Asymptomatic disease was determined in 199 (47%) patients. Male patients had significantly lower levels of P. Symptomatic patients and patients with renal stones, vitamin D < 20 µg/l, calcium level ≥ 11.2 mg/dl, 24 h urinary calcium > 400 mg/day, or hypomagnesemia, were seen to have significantly lower levels of P (p < 0.05). Hypophosphatemia (hypoP) was found in 202 of 424 patients (47%), and these patients had a higher rate of symptomatic disease (63% to 44%, p < .0001). Of the 61 (88%) patients with moderate hypoP, 54 (88%) had at least one of the surgical criteria. A statistically significant increase in the incidence of hypoP was determined in symptomatic and male patients. In the patients with hypoP, serum PTH and urine calcium levels were found to be higher, and lumbar T-scores and serum vitamin D levels were lower. The patients with hypoP had higher rates of renal stones and osteoporosis (p < 0.05).

Conclusions

The current study results show that hypoP is associated with a higher risk of osteoporosis and renal stones in PHPT patients. Even if patients are asymptomatic, moderate hypoP may be associated with poor outcomes of PHPT. Therefore, moderate hypoP may be a new criterion for parathyroidectomy, regardless of hypercalcemia level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Walker MD, Silverberg SJ (2018) Primary hyperparathyroidism. Nat Rev Endocrinol 14:115–125. https://doi.org/10.1038/nrendo.2017.104

    Article  CAS  PubMed  Google Scholar 

  2. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99:3561–3569. https://doi.org/10.1210/jc.2014-1413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Assadipour Y, Zhou H, Kuo EJ, Haigh PI, Adams AL, Yeh MW (2019) End-organ effects of primary hyperparathyroidism: a population-based study. Surgery 165:99–104. https://doi.org/10.1016/j.surg.2018.04.088

    Article  PubMed  Google Scholar 

  4. Glendenning P, Bell DA, Clifton-Bligh RJ (2014) Investigating hypophosphataemia. BMJ 348:3172. https://doi.org/10.1136/bmj.g3172

    Article  CAS  Google Scholar 

  5. Odvina CV, Sakhaee K, Heller HJ, Peterson RD, Poindexter JR, Padalino PK, Pak CY (2007) Biochemical characterization of primary hyperparathyroidism with and without kidney stones. Urol Res 35:123–128. https://doi.org/10.1007/s00240-007-0096-2

    Article  CAS  PubMed  Google Scholar 

  6. Söreide JA, van Heerden JA, Grant CS, Lo CY, Ilstrup DM (1996) Characteristics of patients surgically treated for primary hyperparathyroidism with and without renal stones. Surgery 120:1033–1038. https://doi.org/10.1016/S0039-6060(96)80051-1

    Article  PubMed  Google Scholar 

  7. Castellano E, Attanasio R, Boriano A, Pellegrino M, Borretta G (2022) Serum phosphate: a neglected test in the clinical management of primary hyperparathyroidism. J Clin Endocrinol Metab 107:612–618. https://doi.org/10.1210/clinem/dgab676

    Article  Google Scholar 

  8. Kızılgül M, Calışkan M, Uçan B, Beysel S, Takır M, Sencar E, Sakız D, Çakal E, Özbek M (2018) Monocyte to HDL cholesterol ratio and its association with cardio-metabolic risk factors in primary hyperparathyroidism. Medeni Med J 33:94–99. https://doi.org/10.5222/MMJ.2018.59837

    Article  Google Scholar 

  9. Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the national bone health alliance working group. Osteoporos Int 25:1439. https://doi.org/10.1007/s00198-014-2655-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ (2010) Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care 14:R147. https://doi.org/10.1186/cc9215

    Article  PubMed  PubMed Central  Google Scholar 

  11. Çalışkan M, Kızılgül M, Beysel S, Uçan B, Akcan F, Takır M, Özbek M, Çakal E (2019) Factors associated with glomerular filtration rate variation in primary hyperparathyroidism after parathyroidectomy. Turk J Med Sci 49:295–300. https://doi.org/10.3906/sag-1806-181

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Bringhurst FR, Demay MB, Kronenberg HM (2020) Hormones and Disorders of Mineral Metabolism. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ (eds) Williams textbook of endocrinology, 14th edn. Elsevier, Philadelphia, pp 1196–1255

    Google Scholar 

  13. Alexander J, Nagi D (2021) Isolated Hypophosphataemia as an Early Marker of Primary Hyperparathyroidism. Endocrinol Diab Metab Case Reports 2021:20–0217. https://doi.org/10.1530/EDM-20-0217

    Article  Google Scholar 

  14. Amanzadeh J, Reilly RF Jr (2006) Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol 2:136–148. https://doi.org/10.1038/ncpneph0124

    Article  CAS  PubMed  Google Scholar 

  15. Fraser WD (2009) Hyperparathyroidism. Lancet 374:145–158. https://doi.org/10.1016/S0140-6736(09)60507-9

    Article  CAS  PubMed  Google Scholar 

  16. Clarke BL (2022) Is Moderate hypophosphatemia a new indication for surgery in asymptomatic primary hyperparathyroidism? J Clin Endocrinol Metab 107:1756–1757. https://doi.org/10.1210/clinem/dgab768

    Article  Google Scholar 

  17. Madeo B, De Vincentis S, Repaci A, Altieri P, Vicennati V, Kara E, Vescini F, Amadori P, Balestrieri A, Pagotto U, Simoni M, Rochira V (2020) The calcium-to-phosphorous (Ca/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study. Endocrine 68(3):679–687. https://doi.org/10.1007/s12020-020-02276-7

    Article  CAS  PubMed  Google Scholar 

  18. Yin M, Liu Q, Wang Q, He Y, Song H, Nie X, Li G (2021) Diagnostic performance of the calcium/phosphate ratio for primary hyperparathyroidism in southwest China. Endocr Connect. 10(11):1387–1392. https://doi.org/10.1530/EC-21-0267

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jayasena CN, Modi M, Palazzo F, De Silva A, Donaldson M, Meeran K, Dhillo WS (2013) Associations of serum 25-hydroxyvitamin D with Circulating PTH, phosphate and calcium in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 78:838–843. https://doi.org/10.1111/cen.12062

    Article  CAS  PubMed  Google Scholar 

  20. Ix JH, Chonchol M, Laughlin GA, Shlipak MG, Whooley MA (2011) Relation of sex and estrogen therapy to serum fibroblast growth factor 23, serum phosphorus, and urine phosphorus: the heart and soul study. Am J Kidney Dis 58:737–745. https://doi.org/10.1053/j.ajkd.2011.06.011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Health Sciences University, Dışkapı Training and Research Hospital, Ziraat Mah. Şehit Ömer Halisdemir Cad. No: 20, 06130, Ankara, Türkiye

    H. Düğer, H. Bostan, Ü. Gül, B. Uçan, S. Hepşen, D. Sakız, P. Akhanlı, E. Çakal & M. Kızılgül

Authors
  1. H. Düğer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Bostan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ü. Gül
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Uçan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Hepşen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Sakız
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Akhanlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Çakal
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Kızılgül
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Düğer.

Ethics declarations

Conflict of interest

The authors have no conflict of interests to declare.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Düğer, H., Bostan, H., Gül, Ü. et al. The importance of hypophosphatemia in the clinical management of primary hyperparathyroidism. J Endocrinol Invest 46, 1935–1940 (2023). https://doi.org/10.1007/s40618-023-02064-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-023-02064-w

Keywords

Search

Navigation