The changing presentation of hyperparathyroidism over 3 decades

Objective: To analyze changes in the presentation of primary hyperparathyroidism over the last 3 decades. Design: Retrospective review. Setting: Tertiary referral center. Patients: Three hundred patients undergoing parathyroidectomy for primary hyperparathyroidism, 100 each in the years 1985, 1995, and 2005. Main Outcome Measures: 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.