title: Primary hyperparathyroidism revisited in menopausal women with serum calcium in the upper normal range at population-based screening 8 years ago.
abstract: Population-based screening showed 2.1% prevalence of primary hyperparathyroidism (pHPT) in postmenopausal women. Individuals with total serum (s)-calcium levels of 2.55 mmol/L or more at screening were diagnosed with pHPT when subsequent analysis supported inappropriately elevated intact parathormone (PTH) levels in relation to even normal s-calcium levels. The arbitrary diagnostic criteria were validated by parathyroidectomy. Herein we reinvestigated biochemical signs of pHPT in women not diagnosed with pHPT due to s-calcium 2.50 to 2.54 mmol/L (group A, n = 160) at screening or due to appropriate PTH levels on two occasions after screening (group B, n = 70). Altogether, 99 women in group A and 47 in group B underwent reinvestigation 8.8 years after screening when they were 65 to 84 years old. The s-calcium levels averaged 2.56 mmol/L and had increased in group A (mean 0.04 mmol/L) and decreased in group B (mean 0.05 mmol/L). A total of 48 and 18 females (48%, 38%), respectively, met the previously validated criteria of pHPT. Altogether 21% of them were hypercalcemic (range 2.60-3.12 mmol/L). Subgroup analysis showed that PTH had not increased with time (n = 47) and that atherogenic blood lipids, but not glucose levels, were similar in pHPT patients and matched controls (n = 37). Assuming the existence of pHPT already at screening, the prevalence of pHPT could be adjusted to 3.4%. Even the most liberal diagnostic criteria utilized at pHPT screening seemed to underdiagnose the disease by inefficient cutoff limits for s-calcium and PTH. Because one-fifth of the women with pHPT progressed to hypercalcemia, long-term follow-up is advocated for those with s-calcium in the upper normal range.
authors.affiliation: Endocrine Unit, Department of Surgery, University Hospital, S-751 85 Uppsala, Sweden. ewa.lundgren@kirurgi.uu.se
authors.forename: Ewa
authors.initials: E
authors.lastname: Lundgren
authors.forename: Emil G
authors.initials: EG
authors.lastname: Hagström
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundin
authors.forename: Kajsa
authors.initials: K
authors.lastname: Winnerbäck
authors.forename: Johanna
authors.initials: J
authors.lastname: Roos
authors.forename: Sverker
authors.initials: S
authors.lastname: Ljunghall
authors.forename: Jonas
authors.initials: J
authors.lastname: Rastad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000453:epidemiology; D008403:Mass Screening; D008593:Menopause / Q000097:blood*; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D015995:Prevalence; D012016:Reference Values
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium