Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 2, March-April, p. 285–293

doi: 10.17219/acem/42626

Publication type: original article

Language: English

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Interdisciplinary Aspects of Primary Hyperparathyroidism: Symptomatology in a Series of 100 Cases

Anna Jodkowska1,A,B,C,D, Krzysztof Tupikowski2,B, Jadwiga Szymczak3,B, Anna Bohdanowicz-Pawlak3,B, Marek Bolanowski3,E, Grażyna Bednarek-Tupikowska3,A,E,F

1 Department and Clinic of Internal and Occupational Diseases and Hypertension, Wroclaw Medical University, Poland

2 Department and Clinic of Urology, Wroclaw Medical University, Poland

3 Department and Clinic of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, Poland

Abstract

Background. Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Beside renal and skeletal complications, it has a wide variety of nonspecific symptoms from other organs that mimic other diseases and delay the diagnosis. In recent decades the clinical profile of PHPT has evolved to less symptomatic forms.
Objectives. The aim of the study was to revise the symptomatology profile of PHPT in a single region, and to facilitate early PHPT diagnosis by encouraging interdisciplinary communication among medical professionals.
Material and Methods. Data from 100 patients (94 women and 6 men, aged 57.1 ± 13.7 years) diagnosed with PHPT in the authors’ center during the past decade were retrospectively analyzed. Biochemical conditions and clinical manifestations (renal, skeletal, cardiovascular, gastrointestinal and asymptomatic) were evaluated.
Results. Renal symptoms were present in 55% of the patients. In the course of unrecognized disease, seven lithotripsy procedures, seven surgical lithotomy procedures and two nephrectomies were performed. Osteoporosis/ /osteopenia was present in 66% and 10% of the study group, respectively. In 16% there were fragility fractures; in 10% brown tumors were present, and 55% of the PHPT patients were hypertensive. Gastrointestinal symptoms were present in 52%; pancreatitis was documented in 3%. PHPT was diagnosed incidentally in asymptomatic patients in 15% of the group. Mean serum Ca was 2.87 mmol/L (SD: 0.36), mean urine Ca was 15.97 mEq/24 h (SD: 7.89), mean serum PTH was 324 pg/mL (SD 425.21). The duration from the appearance of any symptom to the diagnosis varied from < 1 year (19%), 1–10 years (46%) to > 10 years (35%).
Conclusion. PHPT is still diagnosed too late, after a period of untreated symptomatic disease. Multidisciplinary cooperation among specialists on the diagnostic level can help avoid late complications of unrecognized disease.

Key words

osteoporosis, osteoporotic fractures, primary hyperparathyroidism, nephrolithiasis, osteitis fibrosa cystica

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