Symptomatic Hypercalcemia in Patients with Primary Hyperparathyroidism Is Associated with Severity of Disease, Polypharmacy, and Comorbidity

Table 1

Clinical and biochemical differences between PHPT patients experiencing hypercalcemic-related symptoms and asymptomatic PHPT patients.

	Reference range	HS-PHPT	A-PHPT
Patients, n		18	94
Age, years		73.0 (81.5–91.5)	65.0 (55.5–74.0)	0.026
Gender, M/F		3/15	18/76	0.805
BMI, kg/m^2		25.0 (21.0–28.6)	26.5 (23.2–29.7)	0.504
MEN1-related PHPT, %		0.0	8.5	1.000
Calcium phosphate metabolism-related biochemical parameters
Serum calcium, mg/dl	8.4–10.4	12.5 (11.3–13.7)	10.6 (10.3–11.3)	0.001
Ionized calcium, mmol/L	1.18–1.30	1.52 (1.43–1.91)	1.39 (1.28–1.47)	0.001
PTH, pg/ml	10.0–65.0	422.0 (200.0–704.0)	130.0 (90.7–189.8)	0.001
25OHD, ng/ml	>30.0	14.0 (7.1–22.2)	20.1 (10.3–26.7)	0.126
Total ALP, U/L		104.0 (92.2–122.3)	79.5 (60.2–116.0)	0.009
Bone-specific ALP, μg/L	6.0–26.0	33.8 (19.9–42.1)	14.8 (10.8–28.2)	0.010
eGFR, ml/min		71.0 (43.0–96.0)	90.5 (71.8–104.8)	0.015
eGFR < 45 ml/min, %		42.0	5.0	0.050
Serum phosphate, mg/dl	3.50–5.00	2.40 (2.08–2.71)	2.60 (2.20–2.90)	0.371
Urine calcium, mg/kg/24 h	<4.00	4.59 (2.85–6.98)	4.10 (2.80–5.76)	0.520
Urine phosphate, g/24 h	<1.00	0.49 (0.36–0.86)	0.73 (0.56–0.89)	0.028
PHPT-related clinical features
Kidney stones, %		44.0	51.0	0.615
Osteoporosis, %		50.0	52.0	1.000
Hypertension, %		66.0	60.0	0.611
Smokers, %		8.3	13.5	1.000
Metabolic status
Glucose, mg/dl	>100.0	91.0 (81.0–104.5)	90.0 (81.0–96.3)	0.921
Insulin, mU/L	5–25	11.0 (5.9–15.3)	7.3 (2.8–11.6)	0.146
HOMA-IR	<2.5	2.56 (1.09–3.53)	1.62 (0.52–2.85)	0.219
Overt diabetes, %		16.7	5.3	0.087
Total cholesterol, mg/dl	<200.0	188.5 (150.5–211.8)	195.5 (172.8–223.0)	0.130
HDL cholesterol, mg/dl	>40M, >50F	59.0 (46.2–73.7)	56.0 (47.2–67.5)	0.691
LDL cholesterol, mg/dl	<130.0	106.1 (75.9–117.9)	114.1 (94.8–139.9)	0.033
Triglycerides, mg/dl	<150.0	117.0 (92.2–135.5)	98.5 (74.5–123.3)	0.118
Overt dyslipidemia, %		27.0	36.0	0.593
PHPT patients’ health status
Age-adjusted Charlson comorbidity index		3.5 (2.7–5.0)	2.0 (1.0–3.0)	0.001
Chronic medications, n		5.0 (2.2–6.8)	2.0 (0.0–4.0)	0.001

HS-PHPT, hypercalcemic-related symptomatic PHPT patients; A-PHPT, asymptomatic PHPT patients; M/F, male/female; albumin-corrected serum calcium; PTH, parathormone; ALP, alkaline phosphatase; eGFR, estimated glomerular filtration rate; and 25OHD, 25hydroxy-vitamin D.