Primary hyperparathyroidism (PHPT) is caused by the overproduction of parathyroid hormone (PTH) by the parathyroid gland, the symptoms of which can remain dormant until later in life and as such PHPT is often underdiagnosed. We were delighted to speak to Prof. Aliya A. Khan (McMaster University Medical Centre, Hamilton, Canada) around the presentation of PHPT, the reason for underdiagnoses and the complications associated with elevated calcium levels.
The abstract ‘New guidelines on the management of primary hyperparathyroidsm‘ was presented at WCO-IOF-ESCEO 2023, 4-7 May 2023.
- Please could you give us a brief overview of the symptoms of primary hyperparathyroidism (PHPT) and why it is often underdiagnosed? (0:25)
- What complications are associated with elevated calcium levels that are left untreated? (2:22)
Disclosures: Aliya Khan discloses consulting for Amgen and Amolyt; receiving grant/research support from Ascendis, Amolyt, and Calcilytix; serving on advisory boards for Amgen; and receiving honoraria from Amgen.
Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Victoria Jones.
Filmed in coverage of the 2023 WCO-IOF-ESCEO Annual Meeting.
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Please could you give us a brief overview of the symptoms of primary hyperparathyroidism (PHPT) and why it is often underdiagnosed? (0:25)
Yes, initially primary hyperparathyroidism can present with just mild symptoms of hypercalcemia with weakness and fatigue. As the hypercalcemia becomes more significant patients will experience polyuria and polydipsia. They can develop nausea, constipation, vomiting, they can also have confusion and they are complications that can develop. These are largely renal and skeletal, so they can develop osteoporosis as the calcium and phosphate are being released from the skeleton and all this excess calcium is being cleared through the kidney – it can cause kidney stones and nephrocalcinosis, which is calcification of the renal parenchyma, and it can actually impair renal function, and patients can present with fractures. So primary hyperparathyroidism may be present, may be identified if the patient presents with fractures or has osteoporosis – it could be identified on the workup of osteoporosis. These patients may present in the stone clinic with a kidney stone. They could present to the family physician with anxiety or depression or problems with memory, and so it could present in older stages and older ages as well with confusion as the hypercalcemia becomes more significant and in younger people, the polyuria and the polydipsia may be there, also as well as nausea and constipation. So it’s important for us to check serum calcium and check parathyroid hormone if the patient should present with these symptoms.
What complications are associated with elevated calcium levels that are left untreated? (2:22)
So if it’s untreated, the high serum calcium does result in dehydration and shock, as well as severe renal impairment and calcification of the renal parenchyma – fractures can happen. Patients can develop bone disease with lytic lesions, which are quite painful and we had a patient who presented with the serum calcium that was more than 4 millimoles per litre and this patient had a large lytic lesion in the distal femur, and she actually presented because of pain in her leg. When we have such large lesions, this can be one of the manifestations of overt skeletal disease that can happen with primary hyperparathyroidism. Rarely in less than one percent of patients with primary hyperparathyroidism, it can be caused by a cancer – parathyroid cancer – and these patients can have metastatic disease, but this is very rare and usually, skeletal lesions are a reflection of excess PTH with osteitis fibrosa cystica.
Subtitles and transcript are autogenerated.
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