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Classic Primary Hyperparathyroidism Versus Normocalcemic and Normohormonal Variants: Do They Really Differ?

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Abstract

Background

Normocalcemic (NCpHPT) and normohormonal (NHpHPT) variants have been recognized primary hyperparathyroidism entities that pose serious challenges. We sought to define the differences among them in a series of surgically treated patients.

Patients and methods

Between 2011 and 2015, 149 patients were enrolled into three groups: CpHPT (Ca > 10.2 mg/dL, PTH > 65 pg/mL), NCpHPT (normal Ca, PTH > 65 pg/mL) and NHpHPT (Ca > 10.2 mg/dL, normal PTH). Descriptive statistics and inter-group differences were computed, whereas multiple logistic/linear regression tests were used for further analysis.

Results

Of these patients 125 were female and 24 male, mean age 56.3 years (range 8–83). A total of 115 (77.2%) patients presented with CpHPT, 23 (15.4%) with NCpHPT and 11 (7.4%) with NHpHPT. MGD was found in 25 (16.8%) patients and SGD in 124 (83.2%); multivariate analysis failed to reveal statistically significant association of MGD with any pHPT variant (CpHPT 16.5% vs NCpHPT 21.7% vs NHpHPT 9.1%, p = 0.726). Conversely, NCpHPT patients exhibited statistically significant smaller adenoma weight (p = 0.023). Moreover, U/S in these patients had smaller positive predictive value (p = 0.278), whereas concordance between U/S and MIBI was also lower (p = 0.669). The utility of MIBI and U/S differed significantly (p < 0.001); more frequent use of U/S was observed for all groups. However, their predictive values did not differ significantly (p = 0.832).

Conclusions

NCpHPT is more similar than different to CpHPT. NCpHPT constitutes the most challenging entity: it is associated with smaller adenoma weight, whereas U/S exhibited lower positive predictive value and lower concordance rate with MIBI. A trend for higher MGD presence in this group of patients was observed, though without statistical significance.

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Authors and Affiliations

  1. Department of Surgery, 5th Surgical Clinic, Evgenidion Hospital, National and Kapodistrian University of Athens Medical School, Papadiamantopoulou 20 Str., 11528, Athens, Greece

    Andreas Kiriakopoulos & Dimitrios Linos

  2. Institute of Preventive Medicine, Environmental and Occupational Health-Prolepsis, Athens, Greece

    Athanasios Petralias

Authors
  1. Andreas Kiriakopoulos
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  2. Athanasios Petralias
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  3. Dimitrios Linos
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Correspondence to Andreas Kiriakopoulos.

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Kiriakopoulos, A., Petralias, A. & Linos, D. Classic Primary Hyperparathyroidism Versus Normocalcemic and Normohormonal Variants: Do They Really Differ?. World J Surg 42, 992–997 (2018). https://doi.org/10.1007/s00268-018-4512-2

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  • DOI: https://doi.org/10.1007/s00268-018-4512-2

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