[Primary hyperparathyroidism. An underdiagnosed disease in Denmark?].
Population-based investigations measuring serum calcium levels seem to indicate a prevalence of primary hyperparathyroidism (pHPT) of 0.4-1% in adults with a figure of about 3% in women over 60 years of age. Annual incidence rate varies and is found to be about 25-30 new cases per 100,000 adults with routine use of serum calcium measurements in diagnostic work-up. In women over 60 years of age the incidence approaches 200 instances per 100,000 individuals. Autopsy studies have demonstrated parathyroid disease in about 10%, one third as solitary adenomas and two thirds as hyperplasia. Annual incidence of surgical interventions, however, is currently found to be low with a frequency of about 2 instances per 100,000 inhabitants in Denmark, but with somewhat higher figures in Sweden and Finland. Recently, the preoperative diagnosis of pHPT has been considerably simplified and requires in most cases solely the demonstration of sustained raised serum calcium levels associated with elevated serum concentration of intact PTH. Investigations indicate that pHPT is underdiagnosed in Denmark, and indications for surgical treatment appear to be restrictive. Compared with Swedish operation series the weight of parathyroid adenomas in Danish series is found to be 3 times higher and the mass of hyperplasia 9 times higher consistent with significantly more elevated serum calcium concentrations. Arguments are presented in favour of an increased interest in diagnosing pHPT and a more liberal approach in the selection of patients for surgical treatment of mild or even asymptomatic disease. Routine measurement of serum calcium concentration in blood samples from patients might be considered in order to increase the incidence rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Blichert-Toft
M
M
Kirurgisk og medicinsk endokrinologisk afdeling, Rigshospitalet, København.
Mollerup
C L
CL
Feldt-Rasmussen
U F
UF
Daugaard
H
H
Engel
U H
UH
D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged