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The calcium-to-phosphorous (Ca/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study

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Abstract

Purpose

The diagnosis of primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) is still challenging, especially in patients asymptomatic or with non-classical phenotypes and for physicians not skilled in calcium-phosphorous (Ca–P) disorders. The serum calcium/phosphorous (Ca/P) ratio has been proposed as accurate index to identify PHPT, while it has never been tested in HypoPT. The aim of this study is to investigate the diagnostic power of the serum Ca/P ratio in the diagnosis of primary parathyroid dysfunctions (both PHPT and HypoPT) in a large series of data.

Methods

A multicentric, retrospective, cross-sectional study (ClinicalTrials.gov: NCT03747029) was carried out including 432 PHPT patients and 217 HypoPT patients compared with 389 controls. Serum Ca, P, creatinine, parathyroid hormone and 25OH-vitamin D were collected. Serum Ca and P were expressed in mmol/L. Ca/P diagnostic performance was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and accuracy.

Results

The Ca/P ratio was significantly higher in PHPT and lower in HypoPT patients than controls (p < 0.0001). At ROC curve analysis, the Ca/P ratio above 2.55 was defined to identify PHPT patients (sensitivity 85.7%, specificity 85.3%) and below 1.78 to identify HypoPT patients (sensitivity 88.2%, specificity 87.9%).

Conclusions

The Ca/P ratio is a highly accurate index to identify PHPT when Ca/P is above 2.55 and HypoPT when it is below 1.78. These results demonstrate the reliability of this index to rule in/out primary parathyroid dysfunctions and remark the importance of measuring serum P in clinical practice.

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Acknowledgements

The authors thank Prof. Paola Ugolini, Department of Romance Languages, SUNY Buffalo, NY, USA, for having proofread the manuscript and Dr Shaniko Kaleci, Department of Department of Diagnostic Medicine, Clinics and Public Health, Azienda Ospedaliero-Universitaria of Modena, Italy, for her contribution in reviewing statistics and study design.

Author contributions

All authors contributed to the study conception and data collection. Analysis were performed by B.M., S.D.V. and V.R. The first draft of the manuscript was written by B.M. and V.R. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, 41126, Modena, Italy

    Bruno Madeo, Sara De Vincentis, Manuela Simoni & Vincenzo Rochira

  2. Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41126, Modena, Italy

    Sara De Vincentis, Elda Kara, Manuela Simoni & Vincenzo Rochira

  3. Unit of Endocrinology, DIMEC Alma Mater Studiorum Bologna, Policlinico S. Orsola-Malpighi, 40138, Bologna, Italy

    Andrea Repaci, Paola Altieri, Valentina Vicennati & Uberto Pagotto

  4. Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100, Udine, Italy

    Elda Kara & Fabio Vescini

  5. Unit of Endocrinology, Azienda Provinciale Servizi Sanitari Trento, 38122, Trento, Italy

    Pierluigi Amadori

  6. Endocrinology and Diabetology Unit, Department of Internal Medicine, M. Bufalini Hospital, 47521, Cesena, Italy

    Antonio Balestrieri

Authors
  1. Bruno Madeo
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  2. Sara De Vincentis
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  3. Andrea Repaci
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  10. Uberto Pagotto
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  11. Manuela Simoni
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Correspondence to Bruno Madeo.

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The authors declare that they have no conflict of interest.

Ethics

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board approved the protocol study.

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Madeo, B., De Vincentis, S., Repaci, A. et al. The calcium-to-phosphorous (Ca/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study. Endocrine 68, 679–687 (2020). https://doi.org/10.1007/s12020-020-02276-7

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  • DOI: https://doi.org/10.1007/s12020-020-02276-7

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