[Primary hyperparathyroidism. Relationships of symptoms to age, sex, calcemia, anatomical lesions and weight of the glands]

Abstract

Objectives: Primary hyperparathyroidism is a polymorphic disease. We evaluated the effect of different factors on clinical expression.

Methods: Clinical expression in 259 patients who underwent surgery for primary hyperparathyroidism were analyzed as a function of patient age, sex, calcium level, anatomic lesions and weight of the diseased glands.

Results: Behaviour disorders and bone images were more frequent in women and urinary lithasis and gastric ulcers were more frequent in men. Behaviour disorders, bone images, chondrocalcinosis, renal failure and acute episodes were more frequent in elderly patients. Inversely, urinary lithiasis was more frequent in young subjects. The prevalence of asymptomatic forms was not related to the level of calcaemia, even for very high levels. Calcium levels above 3.5 mmol/l led to a significantly higher rate of behaviour disorders and acute episodes. Moderately elevated calcium levels were associated most frequently with urinary lithiasis. There was no evidence that anatomic lesions were related to symptomatology, particularly cancer which was not related with more frequent or more severe forms. Finally, nephrocalcinosis, renal failure and acute episodes were particularly frequent when the weight of the parathyroid tissue was greatest.

Conclusion: The main therapeutic conclusion concerned primary hyperparathyroidism with moderately elevated calcium levels: since there is no difference between the clinical expression of primary hyperparathyroidism with moderately elevated calcaemia, the same surgical approach is recommended.