מאמרים כחול-לבן
| Amer J Med 117: 861-863, 2004 |
| Characterization of normocalcemic primary hyperparathyroidism |
| Karen M. Tordjman, Yona Greenman, Etty Osher, Galina Shenkerman and Naftali Stern |
| aInstitute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel |
| Recently, endocrinologists have become aware of patients with normocalcemic
primary hyperparathyroidism. This entity has not been characterized
systematically, and it is not yet clear whether this is a “forme fruste”
of the disease or a harbinger of the hypercalcemic type . The purpose
of the present study was to define the characteristics of patients
with this diagnosis in one endocrine outpatient clinic during the last
5 years. We reviewed medical records of patients with a diagnosis of
primary hyperparathyroidism (International Classification of Diseases,
Ninth Revision, code 252.0) seen in the endocrine clinic at Tel Aviv
Sourasky Medical Center between January 1998 and October 2003. (Institutional
review board approval was not required for this study.) The diagnosis
of normocalcemic primary hyperparathyroidism was confirmed if a patient
had never had documented hypercalcemia, and if all apparent causes
of secondary hyperparathyroidism had been ruled out. Of the 32 patients with normocalcemic hyperparathyroidism , six patients presented with some degree of hypercalciuria; In 17 patients, the diagnosis of hyperparathyroidism was made after finding osteopenia or osteoporosis and altogether, 77% (20/26) of patients had osteopenia, including 46% (n = 12) with osteoporosis at the lumbar spine. The prevalence of osteopenia at the hip was 64% (16/25), including 36% (n = 9) with osteoporosis.Three patients had nephrolithiasis , 2 had peptic ulcer disease and, 20 patients had hypertension (blood pressure ≥140/90 mm Hg, or treated). In summary, like their hypercalcemic counterparts, patients with normocalcemic primary hyperparathyroidism are largely asymptomatic. They usually come to medical to attention in the context of an evaluation for decreased bone mass. Nevertheless, they often have parathyroid adenomas as well as evidence of metabolic abnormalities and other endocrine conditions. Thus, we believe this is a bona fide disease. We cannot determine whether the patients in our series who underwent surgery would have eventually become hypercalcemic; however, none of the patients who were followed without surgery had any evidence of clinical worsening |