Conference Coverage

Primary hPTH often goes unnoticed

 

Key clinical point: Calcium levels in the high normal range may be confounding diagnoses.

Major finding: About 20% of primary hyperparathyroidism cases could have been spotted by the primary care physician based on tests that had been ordered.

Study details: A retrospective analysis of 742 patients at a tertiary care kidney stone clinic.

Disclosures: The study received no funding. Mr. Boyd declared no relevant financial relationships.

Source: Boyd C et al. AUA 2018, Abstract MP13-03.


 

REPORTING FROM THE AUA ANNUAL MEETING

– Primary hyperparathyroidism was detected in 7% of 742 patients with recurrent kidney stones at a single tertiary care clinic, and the patients’ primary care physicians may have missed the diagnosis because several affected patients’ calcium levels were in the high normal range.

Of the 53 patients diagnosed with primary hyperparathyroidism (hPTH), 72% had high normal serum calcium levels. After examining the charts of those patients, researchers found that 11 of the 53 patients (21%) had been tested for parathyroid hormone and serum calcium levels and could have been identified by their primary care physicians.

Carter Boyd, a medical student at the University of Alabama-Birmingham, who presented the results of the study at the American Urological Association (AUA) Annual Meeting

Carter Boyd

“The data were there, but the diagnosis wasn’t made,” said Carter Boyd, a medical student at the University of Alabama at Birmingham, who presented the results of the retrospective study at the annual meeting of the American Urological Association. With calcium levels in the high normal range, “you don’t even think about hPTH.” Calcium levels can be cyclic and are not necessarily a good measure when used alone for detecting primary hPTH. With parathyroid adenomas, levels aren’t necessarily constantly high.

None of the 742 patients with kidney stones in the study had vitamin D deficiency or gastrointestinal malabsorption. All were tested for serum calcium and intact serum PTH, and those with hypercalcemia or high normal calcium (greater than 10 mg/dL) and elevated intact serum PTH were diagnosed with primary hPTH.

The findings emphasize “the importance of [looking] for not just outright primary hyperparathyroidism, but the ratio between PTH and calcium levels,” said Mr. Boyd.

The study received no funding. Mr. Boyd declared no relevant financial relationships.

SOURCE: Boyd C et al. AUA 2018, Abstract MP13-03.

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