Primary hyperparathyroidism in male and female patients: clinical, biochemical and pathological features in a population of 278 patients who underwent surgery

The overall incidence of primary hyperparathyrodism (HPT) is approximately 1 in 2000, and the disease is two to three times as common in women as in men. The aim of this study was to analyze whether differences exist between men and women with regard to clinical and biochemical features in a population of patients with confirmed primary HPT who underwent successful parathyroidectomy. Patients and Methods: A database of information (age, main clinical and biochemical features, and final histopathology) was recorded, and charts of 278 consecutive patients (median age 58 years, range 13-82 years) with primary HPT were reviewed. There were 212 (76.3%) women (Group A), and 66 (13.5%) men (Group B). Results: Women were significantly older than men (58.9±12.1 vs. 49.4±14.9 years, p=0.000001, t-test). The clinical presentation did not differ significantly (p>0.05) between Groups (hyperparathyroid renal disease=12.7% vs. 21.2%, p=0.21, chi-square test; hyperparathyroid bone disease=40.1% vs. 22.7%, p=0.09; gastrointestinal symptoms=11.3% vs. 18.2%, p=0.29; weakness, lethargy, depression 14.1% vs. 10.6%, p=0.65; no symptoms or signs 21.7% vs. 27.3%, p=0.56). Most laboratory findings were similar in Groups A and B (alkaline phosphatase=132.076.4 vs. 163.0212.0 U/L, p=0.07; serum creatinine=78.423.0 vs. 80.932.6 micromol/L, p=0.49; intact-PTH=175.0139.5 vs. 207.0.9193.0 ng/L, p=0.14), while the mean serum calcium levels were significantly higher in men (3.040.40 vs. 2.890.27, p=0.000001). There was a direct correlation between calcium and PTH serum levels both in Group A (R=0.196, F=8.383, t=102.010, p=0.004) and Group B (R=0.560, F=29.271, t=45.014, p=0.000001), while a relationship between age and serum calcium was found only among women (Group A: R=0.187, F=7.559, T=36.310, p=0.006; Group B: R=0.095, F=0.577, t=18.043, p=0.45). Final pathology showed 228 (82.0%) solitary parathyroid (PT) adenomas, 8 (2.9%) PT carcinomas, and 33 patients (11.9%) with multiglandular disease. PT cancer was more frequent in Group B (7.6% vs. 1.4%, p=0.03). Conclusions: Primary HPT presents similar clinical and biochemical features in men and women. However, in our experience, serum calcium did not correlate (p=NS) with the age of the male patients, although they had higher mean preoperative calcium levels. A role of sex hormones in protecting bone mass against the destructive effects of PTH could be hypothesized.