Primary hyperparathyroidism revisited in menopausal women with serum calcium in upper normal range at population-based screening 8 years ago

• Abstract. Population-based screening showed 2.1% prevalence of primaryhyperparathyroidism (pHPT) in postmenopausal women. Individualswith total serum (s)-calcium levels of 2.55 mmol/L or more at screeningwere diagnosed with pHPT when subsequent analysis supported inappropriatelyelevated intact parathormone (PTH) levels in relation to evennormal s-calcium levels. The arbitrary diagnostic criteria were validatedby parathyroidectomy. Herein we reinvestigated biochemical signs ofpHPT in women not diagnosed with pHPT due to s-calcium 2.50 to 2.54mmol/L (group A, n 160) at screening or due to appropriate PTH levelson two occasions after screening (group B, n 70). Altogether, 99 womenin group A and 47 in group B underwent reinvestigation 8.8 years afterscreening when they were 65 to 84 years old. The s-calcium levels averaged2.56 mmol/L and had increased in group A (mean 0.04 mmol/L) anddecreased in group B (mean 0.05 mmol/L). A total of 48 and 18 females(48%, 38%), respectively, met the previously validated criteria of pHPT.Altogether 21% of them were hypercalcemic (range 2.60 –3.12 mmol/L).Subgroup analysis showed that PTH had not increased with time (n 47)and that atherogenic blood lipids, but not glucose levels, were similar inpHPT patients and matched controls (n 37). Assuming the existence ofpHPT already at screening, the prevalence of pHPT could be adjusted to3.4%. Even the most liberal diagnostic criteria utilized at pHPT screeningseemed to underdiagnose the disease by inefficient cutoff limits for scalciumand PTH. Because one-fifth of the women with pHPT progressedto hypercalcemia, long-term follow-up is advocated for those with scalciumin the upper normal range.

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