Abstract • Patients with normocalcemic hyperparathyroidism represent a diagnostic and therapeutic challenge. It is unclear to what extent these patients benefit from surgery in terms of correction of their serum chemistry abnormalities and their symptoms. We studied 142 patients: 23 with normocalcemic hyperparathyroidism (serum calcium levels below 2.62 mmol/L), 35 with intermittent hypercalcemia, and 84 with hypercalcemic hyperparathyroidism. Serum chemistry analyses and a standardized questionnaire of symptoms were completed before and after surgery. Overall, patients in the normocalcemic group reported a similar frequency of preoperative symptoms; had a similar reduction in postoperative symptoms; and had a similar normalization of serum calcium, parathormone, and phosphate levels as those in the two control groups. This study indicates that factors other than elevated serum calcium levels are in large part responsible for the symptoms of hyperparathyroidism and that these patients benefit from operation. (Arch Surg. 1992;127:1157-1163) References 1. Mather HG. Hyperparathyroidism with normal serum calcium . BMJ . 1953;2:424-425.Crossref 2. Nickles G, Flanagan B. Normocalcemic hyperparathyroidism . Trans Assoc Am Physicians . 1967;80:314. 3. Wills MR, Pak CYC, Hammond WG, Bartter FC. Normocalcemic primary hyperparathyroidism . Am J Med . 1969;47:384-391.Crossref 4. Clark OH, Wilkes W, Siperstein AE, Duh QY. Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy and deficiencies in our knowledge . J Bone Miner Res . 1991;6:S135-142.Crossref 5. Gardin JP, Paillard M. Normocalcemic primary hyperparathyroidism: resistance to PTH effect on tubular reabsorption of calcium . Miner Electrolyte Metab . 1984;10:301-308. 6. Cope O. The study of hyperparathyroidism at the Massachusetts General Hospital . N Engl J Med . 1966;274:1174-1182.Crossref 7. Mundy GR, Cove GH, Fiskin R. Primary hyperparathyroidism: changes in the pattern of clinical presentation . Lancet . 1980;1:1317-1320.Crossref 8. Heath H III, Hodgson SF, Kennedy M. Primary hyperparathyroidism: incidence, morbidity and potential economic impact in the community . N Engl J Med . 1980;302:189-193.Crossref 9. Duh QY, Arnaud CD, Levin KE, Clark OH. Parathyroid hormone: before and after parathyroidectomy . Surgery . 1986;100:1021-1031. 10. McLeod MK, Monchik JM, Marin HG. The role of ionized calcium in the diagnosis of subtle hypercalcemia in symptomatic primary hyperparathyroidism . Surgery . 1984;95:667-673.
Archives of Surgery – American Medical Association
Published: Oct 1, 1992