SAN DIEGO – Contrary to conventional wisdom, primary hyperparathyroidism is not extremely rare among people younger than 30 years, and it presents differently in these patients, compared with those older than 60 years, according to an analysis of data from 335 consecutive patients.
"Since routine calcium screening is not done in younger patients, primary hyperparathyroidism should be considered when nephrolithiasis, GERD [gastroesophageal reflux disease], and bone disease occur in patients younger than 30 years," Dr. Jovenel Cherenfant of the University of Chicago and his colleagues concluded.
To identify differences in hyperparathyroidism among age groups, the researchers reviewed data from 335 consecutive patients who underwent parathyroidectomy at a single center between 1998 and 2009.
The study population included 40 patients younger than 30 years, 155 patients aged 30-60 years, and 140 patients older than 60 years. Approximately 63% were women.
Prior to surgery, calcium and parathyroid hormone levels were significantly higher in patients younger than 30 years, compared with those older than 60 years. Presurgical calcium levels in patients younger than 30 years and those older than 60 years were 11.7 mg/dL and 10.9 mg/dL, respectively. Presurgical parathyroid hormone levels for the older and younger groups were 290 pg/mL and 159 pg/mL, respectively. All levels returned to normal after surgery; the median postoperative calcium and intact parathyroid hormone values for all patients were 9.35 mg/dL and 42.1 pg/mL, respectively, according to the results, which were presented in a poster at the annual meeting of the American Association of Clinical Endocrinologists.
At presentation, 58% of patients younger than 30 years complained of GERD, compared with 26% of those aged 30-60 years and 23% of those older than 60 years.
After the researchers controlled for age, women had a higher prevalence of GERD and osteoporosis, compared with men. Men of all ages were more likely to have a history of kidney stones, compared with women, but kidney stones were more common in younger women, compared with older women (40% of women younger than 30 years vs. 12% of women older than 30 years).
In addition, osteoporosis was significantly more common in patients older than 60 years vs. those younger than 30 years (49% vs. 9%), but 63% of the younger women had osteopenia, vs. 43% of those older than 60 years.
Dr. Cherenfant had no financial conflicts to disclose.