Skip to main content

Advertisement

SpringerLink
Log in

Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Normocalcemic primary hyperparathyroidism (NC-PHPT) is a variant of hyperparathyroidism, characterized by normal serum calcium levels, high parathyroid hormone (PTH) and normal 25-OH vitamin D status. The present study aimed to compare complications related to hyperparathyroidism in patients with NC-PHPT and hypercalcemic PHPT (HC-PHPT). We retrospectively evaluated the records of 307 PHPT patients between January 2010 and March 2013. We excluded patients with impaired renal function and liver failure. All patients underwent a biochemical and hormonal examination including serum glucose, albumin, total calcium, phosphorus, creatinine, lipoproteins, PTH and 25-OH vitamin D. Nephrolithiasis and bone mineral density were documented based on a review of the medical records. The study population consisted of 36 (12 %) males and 271 (88 %) females with a mean age of 53.3 ± 9.5 years (29–70 years). Twenty-three of the patients were diagnosed with NC-PHPT (group 1) and 284 were diagnosed with HC-PHPT (group 2). There were no significant differences in terms of age, gender, prevalence of hypertension, low bone mineral density and kidney stones between the groups. The mean thyroid-stimulating hormone (TSH) and low-density lipoprotein (LDL) levels were significantly higher in group 1 than in group 2. Our study found that patients with NC-PHPT have similar several complications as patients with HC-PHPT. NC-PHPT patients have higher TSH levels despite being within the normal range, and higher LDL-C levels than patients with HC-PHPT. However, this relationship needs to be clarified in future studies with larger cohorts.

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. Yu N, Donnan PT, Murphy MJ, Leese GP (2009) Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol 71:485–493

    Article  Google Scholar 

  2. Adami S, Marcocci C, Gatti D (2002) Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 17:18–23

    Google Scholar 

  3. Farahnak P, Larfars G, Sten-Linder M, Nilsson IL (2011) Mild primary hyperparathyroidism: 25-OH Vitamin D deficiency and cardiovascular risk markers. J Clin Endocrinol Metab 96:2112–2118

    Article  CAS  PubMed  Google Scholar 

  4. Wermers RA, Khosla S, Atkinson EJ, Grant CS, Hodgson SF, O’Fallon WM, Melton LJ (1998) Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med 104:115–122

    Article  CAS  PubMed  Google Scholar 

  5. Hagstrom E, Lundgren E, Rastad J, Hellman P (2006) Metabolic abnormalities in patients with normocalcemic hyperparathyroidism detected at a population-based screening. Eur J Endocrinol 155:33–39

    Article  PubMed  Google Scholar 

  6. Ross AC, Taylor CL, Yaktine AL, Del Valle HB (eds) (2011) Dietary reference intakes for calcium and 25-OH vitamin D. The National Academies Press, Washington

    Google Scholar 

  7. Bilezikian JP, Silverberg SJ (2010) Normocalcemic primary hyperparathyroidism. Arq Bras Endocrinol Metabol 54:106–109

    Article  PubMed  PubMed Central  Google Scholar 

  8. Silverberg SJ, Bilezikian JP (2003) Incipient primary hyperparathyroidism: a forme fruste of an old disease. J Clin Endocrinol Metab 88:5348–5352

    Article  CAS  PubMed  Google Scholar 

  9. Cusano NE, Silverberg SJ, Bilezikian JP (2013) Normocalcemic primary hyperparathyroidism. J Clin Densitom 16:33–39

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grant FD, Conlin PR, Brown EM (1990) Rate and concentration dependence of parathyroid hormone dynamics during stepwise changes in serum ionized calcium in normal humans. J Clin Endocrinol Metab 71:370–378

    Article  CAS  PubMed  Google Scholar 

  11. Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K, Lewis C, Cawthon PM, Marcus R, Marshall LM, McGowan J, Phipps K, Sherman S, Stefanick ML, Stone K (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585

    Article  PubMed  Google Scholar 

  12. Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ (2007) Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 92:3001–3005

    Article  CAS  PubMed  Google Scholar 

  13. Maruani G, Hertig A, Paillard M, Houillier P (2003) Normocalcemic primary hyperparathyroidism: evidence for a generalized target-tissue resistance to parathyroid hormone. J Clin Endocrinol Metab 88:4641–4648

    Article  CAS  PubMed  Google Scholar 

  14. Tordjman KM, Greenman Y, Osher E, Shenkerman G, Stern N (2004) Characterization of normocalcemic primary hyperparathyroidism. Am J Med 117:861–863

    Article  PubMed  Google Scholar 

  15. Amaral LM, Queiroz DC, Marques TF, Mendes M, Bandeira F (2012) Normocalcemic versus hypercalcemic primary hyperparathyroidism: more stone than bone? J Osteoporos 3:128352

    Google Scholar 

  16. Cakir I, Unluhizarci K, Tanriverdi F (2012) Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism. Endocrine 42:419–422

    Article  CAS  PubMed  Google Scholar 

  17. Gillet C, Bergmann P, Francois D, Body JJ, Corvilain J (1989) Low basal thyrotropin with normal thyroid function in primary hyperparathyroidism. Acta Endocrinol 121:638–642

    CAS  PubMed  Google Scholar 

  18. Ignjatovic VD, Matovic MD, Vukomanovic VR, Jankovic SM, Džodić RR (2013) Is there a link between Hashimoto’s thyroiditis and primary hyperparathyroidism? A study of serum parathormone and anti-TPO antibodies in 2267 patients. Hell J Nucl Med 16:86–90

    PubMed  Google Scholar 

  19. Hagström E, Lundgren E, Rastad J, Hellman P (2006) Metabolic abnormalities in patients with normocalcemic hyperparathyroidism detected at a population-based screening. Eur J Endocrinol 155:33–39

    Article  PubMed  Google Scholar 

  20. Temizkan S, Kocak O, Aydin K, Ozderya A, Arslan G, Yucel N, Sargin M (2014) Normocalcemic hyperparathyroidism and insulin resistance. Endocr Pract 6:1–19

    Google Scholar 

Download references

Acknowledgments

We thank Prof Alpaslan Kemal Tuzcu from Dicle University School of Medicine for critical review of the manuscript. This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Dicle University School of Medicine, Sur, Diyarbakır, Turkey

    Mazhar Müslüm Tuna

  2. Endocrinology and Metabolism Department, Dışkapı Training and Research Hospital, Ankara, Turkey

    Mustafa Çalışkan, Taner Demirci, Mustafa Özbek & Tuncay Delibaşı

  3. Endocrinology and Metabolism Department, Numune Training and Research Hospital, Ankara, Turkey

    Mustafa Ünal, Berçem Ayçiçek Doğan & Dilek Berker

  4. Endocrinology and Metabolism Department, Hitit University School of Medicine, Çorum, Turkey

    Kerim Küçükler & Serdar Güler

Authors
  1. Mazhar Müslüm Tuna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mustafa Çalışkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mustafa Ünal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taner Demirci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Berçem Ayçiçek Doğan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kerim Küçükler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mustafa Özbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dilek Berker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tuncay Delibaşı
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Serdar Güler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mazhar Müslüm Tuna.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tuna, M.M., Çalışkan, M., Ünal, M. et al. Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism. J Bone Miner Metab 34, 331–335 (2016). https://doi.org/10.1007/s00774-015-0673-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-015-0673-3

Keywords

Search

Navigation