Abstract：
Primary hyperparathyroidism (PHPT) is commonly diagnosed in the setting of hypercalcemia, whereas normocalcemic primary hyperparathyroidism (NHPT) may be misdiagnosed.
Our objective was to compare hypercalcemic hyperparathyroidism (HPHPT) versus NHPT hypercalciuric renal stone patients.
We took advantage of a routine calcium load test performed in hypercalciuric renal stone patients to assess retrospectively among PHPT patients, prevalence and characteristics of NHPT and HPHPT under a calcium restricted diet.
Among 1671 hypercalciuric patients included, 91 patients have a final diagnosis of PHPT(post load ionized calcium (iCa)>1.31 mmol/L and PTH>30 pg/ml). Prevalence of NHPT is 40% of all PHPT, however according to total serum calcium 4/35 NHPT and 7/56 HPHPT would have been misclassified in the other group. 18/35 NHPT and 40/56 HPHPT underwent parathyroidectomy. No significant characteristics related to parathyroid weight, stone composition or bone remodeling biomarkers is detected between groups. Whereas iCa is higher in HPHPT in fasting state and after calcium load, we found no difference for calcium diet, 24-hour calciuria, or calcitriol. Of notice, renal calcium excretion (FECa) post load increases by 303% in NHPT but only 176% in HPHPT (p=0.01) likely explained by a lesser PTH decrease (p=0.02). However, a strong negative association (p<0.0001) detected between pooled pre and post load iCa and PTH only in NHPT group suggests a persistent efficient PTH-CaSR control within parathyroid glands in this group.
Our data show the relevance of dynamic tests to unmask NHPT in hypercalciuric renal stone patients.
Our objective was to compare hypercalcemic hyperparathyroidism (HPHPT) versus NHPT hypercalciuric renal stone patients.
We took advantage of a routine calcium load test performed in hypercalciuric renal stone patients to assess retrospectively among PHPT patients, prevalence and characteristics of NHPT and HPHPT under a calcium restricted diet.
Among 1671 hypercalciuric patients included, 91 patients have a final diagnosis of PHPT(post load ionized calcium (iCa)>1.31 mmol/L and PTH>30 pg/ml). Prevalence of NHPT is 40% of all PHPT, however according to total serum calcium 4/35 NHPT and 7/56 HPHPT would have been misclassified in the other group. 18/35 NHPT and 40/56 HPHPT underwent parathyroidectomy. No significant characteristics related to parathyroid weight, stone composition or bone remodeling biomarkers is detected between groups. Whereas iCa is higher in HPHPT in fasting state and after calcium load, we found no difference for calcium diet, 24-hour calciuria, or calcitriol. Of notice, renal calcium excretion (FECa) post load increases by 303% in NHPT but only 176% in HPHPT (p=0.01) likely explained by a lesser PTH decrease (p=0.02). However, a strong negative association (p<0.0001) detected between pooled pre and post load iCa and PTH only in NHPT group suggests a persistent efficient PTH-CaSR control within parathyroid glands in this group.
Our data show the relevance of dynamic tests to unmask NHPT in hypercalciuric renal stone patients.
摘要：
背景：原发性甲状旁腺功能亢进（PHPT）通常诊断为高钙血症，而正常血钙的原发性甲状旁腺功能亢进（NHPT）可能被误诊。
目的：我们的目的是比较高钙血症性甲状旁腺功能亢进（HPHPT）和NHPT高钙尿性肾结石患者。
方法：我们利用对高钙性肾结石患者进行的常规钙负荷试验对PHPT患者进行回顾性评估，钙限制饮食下NHPT和HPHPT的患病率和特征。
结果：在1671名高钙尿症患者中，91例患者最终诊断为PHPT(负荷后离子钙(iCa)>1.31mmol/L且PTH>30pg/ml)。NHPT的患病率是所有PHPT的40%，然而,根据血清总钙,另一组中4/35NHPT和7/56HPHPT会被错误分类.18/35NHPT和40/56HPHPT行甲状旁腺切除术。与甲状旁腺重量相关的无显著特征，在组间检测结石成分或骨重建生物标志物。而在空腹状态和钙负荷后，HPHPT中的iCa较高，我们发现钙饮食没有区别，24小时钙尿症,或者骨化三醇.通知，在NHPT中,负荷后肾钙排泄(FECa)增加了303%,但在HPHPT中只有176%(p=0.01),这可能是PTH降低较小(p=0.02)所解释的.然而,仅在NHPT组中,在合并的负荷前后iCa和PTH之间检测到强烈的负相关性(p<0.0001),提示该组甲状旁腺内存在持续有效的PTH-CaSR控制.
结论：我们的数据显示了动态测试与高钙化性肾结石患者的NHPT暴露的相关性。
目的：我们的目的是比较高钙血症性甲状旁腺功能亢进（HPHPT）和NHPT高钙尿性肾结石患者。
方法：我们利用对高钙性肾结石患者进行的常规钙负荷试验对PHPT患者进行回顾性评估，钙限制饮食下NHPT和HPHPT的患病率和特征。
结果：在1671名高钙尿症患者中，91例患者最终诊断为PHPT(负荷后离子钙(iCa)>1.31mmol/L且PTH>30pg/ml)。NHPT的患病率是所有PHPT的40%，然而,根据血清总钙,另一组中4/35NHPT和7/56HPHPT会被错误分类.18/35NHPT和40/56HPHPT行甲状旁腺切除术。与甲状旁腺重量相关的无显著特征，在组间检测结石成分或骨重建生物标志物。而在空腹状态和钙负荷后，HPHPT中的iCa较高，我们发现钙饮食没有区别，24小时钙尿症,或者骨化三醇.通知，在NHPT中,负荷后肾钙排泄(FECa)增加了303%,但在HPHPT中只有176%(p=0.01),这可能是PTH降低较小(p=0.02)所解释的.然而,仅在NHPT组中,在合并的负荷前后iCa和PTH之间检测到强烈的负相关性(p<0.0001),提示该组甲状旁腺内存在持续有效的PTH-CaSR控制.
结论：我们的数据显示了动态测试与高钙化性肾结石患者的NHPT暴露的相关性。
