(0413) The Development of Primary Hyperparathyroidism in Patients With Nonspecific Symptoms

Introduction: In contrast with “classical,” primary hyperparathyroidism (pHPT), “asymptomatic” pHPT describes patients lacking obvious signs and symptoms of excess calcium or parathyroid hormone. Previous studies have discussed pHPT as underdiagnosed and suboptimally treated despite silent organ damage associated with asymptomatic pHPT. This study, the largest to date, explores and compares classic and clinically non-specific symptoms and the development of pHPT.

Methods: We conducted a cohort study using the claims database TriNetX. Patients were included in classic and non-specific clinical symptom groups based on ICD-10 code documentation of clinically pertinent diagnoses and symptoms related to pHPT. Patients < 35 years of age and those with chronic kidney disease, familial/secondary HPT, or pituitary, thyroid, or adrenal tumors were excluded. Outcomes included pHPT diagnosis, parathyroidectomy, and elevated plasma calcium, parathyrin hormone, and vitamin D. Statistics were conducted using TriNetX software.

Results: Our groups included 2,701,872 patients with non-specific symptoms of pHPT and 12,348,941 patients with classic symptoms of pHPT. The presence of any symptoms of pHPT had a 12.3% greater risk for elevated plasma calcium findings and a 2.0% greater risk of elevated parathyrin hormone compared to the absence of these symptoms (p < 0.01 for both). Compared to no relevant clinical symptoms of pHPT, non-specific symptoms were associated with a 2.8% greater risk of elevated calcium findings (p < 0.01). Compared to classic symptoms, non-specific symptoms were not associated with a significant difference in average serum calcium levels (0.1 mean difference, p< 0.01).

Conclusions: Our results indicate that non-specific pHPT symptoms are associated with an increased risk for elevated serum calcium and parathyrin hormone laboratory values. In addition to classic symptoms of pHPT, those with non-specific pHPT symptoms should also have a low threshold for calcium level screening and pHPT work-up as a potential contributor to symptomology.