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The Role of Gender in Primary Hyperparathyroidism: Same Disease, Different Presentation

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hyperparathyroidism is much more common in women and therefore may represent different diseases in men and women. In order to understand the role of gender in hyperparathyroidism, we reviewed our experience.

Methods

We analyzed a prospective database of 1309 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution between March 2001 and August 2010.

Results

The female-to-male ratio was 3.3:1, and female patients were older at presentation (60 ± 0 vs. 57 ± 1 years, p < 0.005). Male patients were more commonly asymptomatic at presentation (25 % vs. 18 %, p = 0.005) and the most common symptom for men was kidney stones (23 % vs. 13 %, p < 0.0001). For patients with bone density scans, osteoporosis was more common in women (34 % vs. 17 %, p < 0.0001). Men had a slightly higher preoperative serum calcium level (11.1 ± 0 vs. 11.0 ± 0 mg/dl, p = 0.03), higher parathyroid hormone level (140 ± 7 vs. 124 ± 4 pg/ml, p = 0.04), higher urinary calcium level (376 ± 10 vs. 314 ± 5 mg/24 h, p < 0.005), and lower vitamin D level (28 ± 1 vs. 32 ± 0 ng/ml, p < 0.005). Men were more likely to have abnormally elevated creatinine values (15 % vs. 9 %, p = 0.004). The operative approach as well as the number of glands involved and their location did not significantly differ between the groups. The mean gland weight for a single adenomas was higher in male patients (1123 ± 128 vs. 636 ± 32 mg, p = 0.001). No significant difference was identified in the immediate and remote postoperative course.

Conclusions

Hyperparathyroidism appears to present differently depending on gender. Male patients more often present without symptoms, present with vitamin D deficiency, and have larger parathyroid glands. Importantly, surgical outcomes were equivalent between men and women.

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References

  1. Felix M. Therapeutischer versuch bein einem falls von otitis fibrosa generalisata mittles. Exstirpation eines epithelkorperchentumors. Wien Klin Wochenschr Zentral. 1926;53:260–4.

    Google Scholar 

  2. Cope O. The study of hyperparathyroidism at the Massachusetts General Hospital. N Engl J Med. 1966;274:1174–82.

    Article  PubMed  CAS  Google Scholar 

  3. Fraser WD. Hyperparathyroidism. Lancet. 2009;374:145–58.

    Article  PubMed  CAS  Google Scholar 

  4. Miller BS, Dimick J, Wainess R, Burney RE. Age- and sex-related incidence of surgically treated primary hyperparathyroidism. World J Surg. 2008;32:795–9.

    Article  PubMed  Google Scholar 

  5. Melton LJ 3rd. The epidemiology of primary hyperparathyroidism in North America. J Bone Miner Res. 2002;17(Suppl 2):N12–7.

    PubMed  Google Scholar 

  6. Rude RK. Hyperparathyroidism. Otolaryngol Clin North Am. 1996;29:663–79.

    PubMed  CAS  Google Scholar 

  7. Caron NR, Pasieka JL. What symptom improvement can be expected after operation for primary hyperparathyroidism? World J Surg. 2009;33:2244–55.

    Article  PubMed  Google Scholar 

  8. Kelly KJ, Chen H, Sippel RS. Primary hyperparathyroidism. Cancer Treat Res. 2010;153:87–103.

    Article  PubMed  Google Scholar 

  9. Bilezikian JP, Khan AA, Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Third International Workshop. J Clin Endocrinol Metab. 2009;94:335–9.

    Article  PubMed  CAS  Google Scholar 

  10. Adler JT, Sippel RS, Schaefer S, Chen H. Surgery improves quality of life in patients with “mild” hyperparathyroidism. Am J Surg. 2009;197:284–90.

    Article  PubMed  Google Scholar 

  11. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–7.

    Article  PubMed  Google Scholar 

  12. Sneider MS, Solorzano CC, Montano RE, Anello C, Irvin GL 3rd, Lew JI. Sporadic primary hyperparathyroidism in young individuals: different disease and treatment? J Surg Res. 2009;155:100–3.

    Article  PubMed  Google Scholar 

  13. Kandil E, Tsai HL, Somervell H, et al. African Americans present with more severe primary hyperparathyroidism than non–African Americans. Surgery. 2008;144:1023–6.

    Article  PubMed  Google Scholar 

  14. Barker H, Caldwell L, Lovato J, Woods KF, Perrier ND. Is there a racial difference in presentation of primary hyperparathyroidism? Am Surg. 2004;70:504–6.

    PubMed  Google Scholar 

  15. Ballem N, Greene AB, Parikh RT, Berber E, Siperstein A, Milas M. Appreciation of osteoporosis among men with hyperparathyroidism. Endocr Pract. 2008;14:820–31.

    PubMed  Google Scholar 

  16. Richert L, Trombetti A, Herrmann FR, et al. Age and gender distribution of primary hyperparathyroidism and incidence of surgical treatment in a European country with a particularly high life expectancy. Swiss Med Wkly. 2009;139:400–4.

    PubMed  Google Scholar 

  17. Hughes P. The CARI guidelines. Kidney stones epidemiology. Nephrology (Carlton). 2007;12(Suppl 1):S26–30.

    Article  Google Scholar 

  18. Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116:c159–71.

    Article  PubMed  Google Scholar 

  19. Worcester EM, Coe FL. Clinical practice. Calcium kidney stones. N Engl J Med. 2010;363:954–63.

    Article  PubMed  CAS  Google Scholar 

  20. Jordan KM, Cooper C. Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol. 2002;16:795–806.

    Article  PubMed  CAS  Google Scholar 

  21. Moretz WH 3rd, Watts TL, Virgin FW Jr, Chin E, Gourin CG, Terris DJ. Correlation of intraoperative parathyroid hormone levels with parathyroid gland size. Laryngoscope. 2007;117:1957–60.

    Article  PubMed  CAS  Google Scholar 

  22. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006;141:777–82.

    Article  PubMed  Google Scholar 

  23. Khan AA, Bilezikian JP, Potts JT Jr. The diagnosis and management of asymptomatic primary hyperparathyroidism revisited. J Clin Endocrinol Metab. 2009;94:333–4.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Herbert Chen MD, FACS.

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Mazeh, H., Sippel, R.S. & Chen, H. The Role of Gender in Primary Hyperparathyroidism: Same Disease, Different Presentation. Ann Surg Oncol 19, 2958–2962 (2012). https://doi.org/10.1245/s10434-012-2378-3

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  • DOI: https://doi.org/10.1245/s10434-012-2378-3

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