Hypercalcaemia: primary hyperparathyroidism: most cases were asymptomatic when detected

Clinical bottom line (level 4)

  1. Primary hyperparathyroidism was the commonest cause of hypercalcaemia, followed by malignancy
  2. Around half of patients with primary hyperparathyroidism were asymptomatic at presentation.
Mundy et al: Lancet 1980; ( 1 ): 1317-1320
Expires October 2005

The study

Setting: 6 acute hospitals, UK, 1979

207 patients (aged ?, ?% male)

Non-independent ?blinded reference standard, applied in all patients from a ?consecutive appropriate spectrum.
Reference standard:
  • primary hyperparathyroidism diagnosed if
    • histological evidence on parathyroidectomy
    • raised PTH levels and clinical features consistent with the disease and no other obvious cause for hypercalcaemia
    • hypercalcaemia for > 1 year without another cause found after careful examination
Diagnostic test: clinical features

The evidence


differential diagnosis number of patients prevalence
(95% CI)
primary hyperparathyroidism 111 54%
(47% to 60%)
malignancy 72 35%
(28% to 41%)
unknown 19 9.2%
(5.2% to 13%)
sarcoidosis 2 1.0%
(0.0% to 2.3%)
thyrotoxicosis 1 0.5%
(0.0% to 1.4%)
immobilisation 1 0.5%
(% to %)
vitamin D intoxication 1 0.5%
(0.0% to 1.4%)


diagnostic test number of patients sensitivity for
hypercalcaemia
(95% CI)		 LR+ LR-
asymptomatic 57%
(% to %)
confusion and dehydration 14%
(9% to 19%)
symptoms of hypercalcaemia (lethargy, polyuria) 8%
(4% to 12%)
renal (stones or decreased function) 7%
(4% to 11%)
hypertension 5%
(2% to 8%)
psychiatric disorder 5%
(2% to 8%)
GI symptoms 4%
(1% to 6%)
bone disease 0%
(0.0% to 1.4%)
total

Comments

  1. The study noted a signficant change in presentation style for primary hyperparathyroidism following the introduction of routine screening for serum calcium in the mid-1970s. Prior to then, most patients diagnosed presented with urinary stones.

Citation

  1. Mundy GR, Cove DH, Fisken R: primary hyperparathyroidism: changes in the pattern of clinical presentation. Lancet 1980; ( 1 ): 1317-1320
Search Terms: ?
Contributor: Clare Wotton, Musab Hayatli, October 2001
Reviewer: Chris Ball

Clinical Question.
Patient hypercalcaemia
Intervention or Exposure clinical features
Outcome primary hyperparathyroidism, differential diagnosis