title: Concentration of serum calcium is not correlated with symptoms or severity of primary hyperparathyroidism: An examination of 20,081 consecutive adults.
abstract: Guidelines for operative treatment of primary hyperparathyroidism include calcium levels >1 mg/dL above normal. We sought to determine whether greater calcium concentrations were associated with increased symptoms or disease severity.
  
  
  
  A retrospective review of a prospectively maintained database of adults undergoing parathyroidectomy for primary hyperparathyroidism, grouped according to greatest preoperative calcium level: those patients with calcium concentrations between 10.0 and 11.0 mg/dL and those with >11.0 mg/dL. We compared subjective symptoms and objective measures of disease severity.
  
  
  
  The review included 20,081 adults who were split nearly evenly between calcium concentrations between 10.0 and 11.0 (10,430, 51.9%) and those with >11.0 mg/dL (9,651, 48.1%). In both groups, an absence of symptoms related to primary hyperparathyroidism was uncommon (<5%). All subjective and objective measures of disease severity were nearly identical with no significant differences (percentages for calcium concentrations between 10.0 and 11.0 and those with >11.0 mg/dL, respectively), including fatigue (72% for both groups), heartburn (37% vs 34%), bone pain (50% vs 48%), sleep disturbances (68% vs 65%), osteoporosis (40% in both groups), kidney stones (21% vs 22%), chronic kidney disease with glomerular filtration rate <60 (29% vs 32%), and hypertension (50% vs 53%).
  
  
  
  Serum calcium concentrations of greater than or less than 11 mg/dL are unrelated to symptoms and disease severity in primary hyperparathyroidism. There is no evidence to support a serum calcium threshold in parathyroidectomy guidelines.
authors.affiliation: Norman Parathyroid Center, Tampa, FL. Electronic address: dboone@parathyroid.com.
authors.forename: Deva
authors.initials: D
authors.lastname: Boone
authors.affiliation: Norman Parathyroid Center, Tampa, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Politz
authors.affiliation: Norman Parathyroid Center, Tampa, FL.
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Norman Parathyroid Center, Tampa, FL.
authors.forename: Jamie
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: Norman Parathyroid Center, Tampa, FL.
authors.forename: Kevin
authors.initials: K
authors.lastname: Parrack
authors.affiliation: Norman Parathyroid Center, Tampa, FL.
authors.forename: James
authors.initials: J
authors.lastname: Norman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D002118:Calcium