Menopause influences primary hyperparathyroidism symptoms

Primary hyperparathyroidism, or PHPT, showed similar biochemical activity regardless of sex, but the disorder presents differently in men and women, researchers in Italy reported.

They attributed the disparity largely to menopause.

“Women worldwide are about three times more commonly affected by PHPT than men, and this sexual dimorphism in epidemiology seems to widen in patients over 50 years old,” Elena Castellano, MD, of the department of endocrinology, diabetes and metabolism at Santa Croce and Carle Hospital in Cuneo, Italy, and colleagues wrote. “Therefore, the highest prevalence of PHPT is reported in women after menopause. A limited number of studies have focused on gender differences in the clinical presentation of PHPT, reporting a more severe derangement of biochemical indices of disease in males. … To the best of our knowledge, there are no public reports exploring the influence of menopause on the clinical presentation of PHPT.”

The researchers performed a retrospective study using medical records from 417 patients who were diagnosed with PHPTPHPT at an Italian hospital between 1998 and 2016.

Among the cohort, men were younger than women (P = .046) and were symptomatic more frequently (62.3% vs. 47%; P = .016), the researchers reported. There was no difference between men and women in serum parathyroid hormone, creatinine, 25-hydroxyvitamin D, calcium and urinary calcium levels, Castellano and colleagues wrote.

Nephrolithiasis, which researchers identified with imaging or by a patient’s history of passing kidney stones, occurred more frequently in men than women (50.5% vs. 33%; P = .003), whereas osteoporosis was more common in women than men (52.2% vs. 35.5%; P = .0066). Fewer than half of postmenopausal women (43.3%) were symptomatic vs. 64.8% of premenopausal women and 62.3% of men, the researchers reported.

Postmenopausal women had a lower incidence of kidney stones compared with premenopausal women (28.1% vs. 59.2%), and a higher incidence of osteoporosis (58.9% vs. 18.5%), the researchers wrote. However, there was no difference in the proportion of men and women who were referred for surgery (84.6% vs. 84.9%).

“Since the biochemical markers of PHPT severity were similar among groups, estrogen deficiency would seem to represent the main determinant influencing the clinical presentation of PHPT in [postmenopausal women],” the researchers wrote. “In spite of the different clinical presentations, surgical indications appear to be met in very high proportion regardless of gender.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.