Abstract
Background
Primary hyperparathyroidism is characterized by hypercalcemia with inappropriately
normal or elevated parathyroid hormone. However, the absolute parathyroid hormone
value that is defined as inappropriately normal is unclear. We reviewed our experience
with parathyroidectomy in patients with hypercalcemia and parathyroid hormone of ≤50.0
pg/mL (normal range 12.0–88.0 pg/mL).
Methods
A total of 2,349 patients underwent parathyroidectomy for primary hyperparathyroidism
between 2000 and 2021. Of these, 149 patients had preoperative parathyroid hormone
≤50.0 pg/mL (parathyroid hormone ≤50). The biology and outcomes were compared to patients
with parathyroid hormone >50.0 pg/mL (parathyroid hormone >50).
Results
Of the parathyroid hormone ≤50 patients, the median parathyroid hormone was 40.0 pg/mL
(range 11.6–50.0 pg/mL). All patients were found to have abnormal hypercellular parathyroid
glands with a cure rate of 96.7%. When compared to the parathyroid hormone >50 group,
the parathyroid hormone ≤50 group was younger (56 ± 15 vs 60 ± 14 years, P < .001) with a lower body mass index (28.7 ± 7.0 kg/m2 vs 31.2 ± 7.9 kg/m2, P < .001), higher rate of fatigue (73.2% vs 63.0%, P = .033), and higher rate of multiglandular disease (58.9% vs 31.9%, P < .001). There was no difference between the groups with respect to patient demographics,
rate of previous parathyroidectomy, surgical cure, or postoperative complications
(persistent or recurrent hyperparathyroidism and hypocalcemia).
Conclusion
Patients with hypercalcemia and parathyroid hormone ≤50 pg/mL have a similar clinical
presentation and rate of surgical cure to other primary hyperparathyroidism patients
and should be considered for parathyroidectomy. Most of these patients have multiglandular
disease and thus should be considered for bilateral parathyroid exploration.
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Article info
Publication history
Published online: October 04, 2022
Accepted:
May 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Opinion regarding hypercalcemia with a parathyroid hormone level of <50 pg/mL: Is this primary hyperparathyroidism?Surgery
- PreviewWe have read the article “Hypercalcemia with a Parathyroid Hormone Level of ≤50 pg/mL: Is This Primary Hyperparathyroidism?” by Wang R et al, with full interest.1 At the outset, we appreciate the contribution and efforts of authors in highlighting the dilemma of biochemical confirmation of primary hyperparathyroidism (PHPT) in the absence of raised parathyroid hormone (PTH). We have some queries and comments.
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