title: The changing presentation of hyperparathyroidism over 3 decades.
abstract: OBJECTIVE
  To analyze changes in the presentation of primary hyperparathyroidism over the last 3 decades.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Three hundred patients undergoing parathyroidectomy for primary hyperparathyroidism, 100 each in the years 1985, 1995, and 2005.
  
  
  METHODS
  Analysis was performed based on patient age, sex, preoperative calcium value, duration of hypercalcemia, symptoms at presentation, and reason for surgical referral.
  
  
  RESULTS
  Patients from the years 1985, 1995, and 2005 were similar in age and sex. Mean (SEM) preoperative calcium values decreased from 11.8 (0.1) mg/dL in 1985 to 11.2 (0.1) mg/dL in 2005 (P < .001) (to convert milligrams per deciliter to millimoles per liter, multiply by 0.25). The proportion of patients with preoperative calcium values less than 11.0 mg/dL steadily rose from 10% in 1985 to 43% in 2005 (P < .001). The mean (SEM) time from diagnosis of hypercalcemia until surgical referral decreased from 2.5 (0.4) years in 1985 to 1.6 (0.2) years in 2005 (P = .08). The primary reason for referral has shifted toward osteoporosis (20% in 2005 vs 7% in 1985; P = .03). The percentage of patients diagnosed with osteoporosis or osteopenia preoperatively increased from 10% in 1985 to 44% in 2005 (P < .001), and the recognition of these conditions in men increased from 3% to 26% (P = .10).
  
  
  CONCLUSIONS
  Over the last 3 decades, increased awareness of hyperparathyroidism and its consequences as well as the institution of screening bone densitometry have changed the profile of patients who are referred for surgery. Patients are being referred sooner, with a lesser degree of hypercalcemia and greater recognition of osteoporosis.
authors.affiliation: Department of Surgery, A-80, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mazzaglia
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kovach
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: Caldwell
authors.initials: C
authors.lastname: Esselstyn
authors.forename: Allan E
authors.initials: AE
authors.lastname: Siperstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D016105:Parathyroidectomy; D012189:Retrospective Studies; D013997:Time Factors