Increased incidence of malignancy in patients with primary hyperparathyroidism

Abstract

Background/aim: Primary hyperparathyroidism (PHPT) is a disease that is diagnosed more frequently and generally in the asymptomatic period, with widely available biochemical tests. Evidence suggesting an association between PHPT and malignancy risk is increasing. Clarification of this association will be useful in PHPT for malignancy screening and management of patients with PHPT. In this study, we aimed to investigate the frequency of cancer in PHPT patients. Materials and methods:A total of 775 PHPT patients were included in the retrospective study. Demographic, clinical and laboratory data of the patients were evaluated retrospectively.Results: Malignancy was detected in 128 (16.50%) of 775 PHPT patients (female/male: 625/150). The mean age at diagnosis of PHPT was 57.99 ± 10.86 years, and the mean age at diagnosis of malignancy was 57.46 ± 11.17 years. Of the 128 patients with malignancy, 53 (41.40%) were diagnosed in the same year as PHPT. In terms of malignancy types, 51 (6.50%) of 775 PHPT patients had thyroid cancer. Thyroid cancer was followed by breast cancer (2.30%) and stomach cancer (1%) in order of frequency. Conclusion:We think that PHPT patients should be examined more carefully in terms of cancer risk, especially thyroid cancer. More comprehensive studies are needed to clarify the relationship between PHPT and cancer.

Previous, simultaneous, or subsequent occurrence of malignant tumours in patients with primary hyperparathyroidism: a closer look at the single-tertiary-centre cases

“…Palmieri et al showed that the occurrence of all cancer types (21.5%) was significantly higher in patients with pHPT than in patients without pHPT [30]. A study found 16.5% of pHPT patients had an accompanying malignant tumour [10]. Most accompanying neoplasm types were breast, thyroid, prostate, and colon in our study, as in the literature.…”

“…Although there is conflicting evidence, the incidence of malignant tumours has been increasing in patients with pHPT [10]. Various types of malignancies such as breast, colon, prostate, lung, thyroid, skin, bladder, and haematopoietic cancers are more common in this disorder [10][11][12][13][14][15][16][17]. The underlying mechanisms of the coexistence of various neoplasms and pHPT is not clear yet.…”

“…When cases with pHPT were followed over a 28-year period, malignancies were lower than expected in patients with pHPT [26]. However, studies have found an association between pHPT and malignancies [10][11][12][13][14][15][16][17][27][28][29][30][31]. It has been reported that haematopoietic, urinary tract, and thyroid gland malignancies were increased significantly in patients with HPT [12].…”

Possible cancer enhancement impact of parathyroid hormone excess

“…Furthermore, the risk of PHPTH is five times greater in females following 75 years of age (1). Primary hyperparathyroidism is detected by high serum calcium value along with raised serum level of parathormone [parathyroid hormone (PTH)], mainly due to parathyroid adenoma (single gland adenoma), and less frequently hyperplasia of four glands (10-15% of cases) and also rarely due to parathyroid malignancy (<1% of cases) (2,3). Hyperparathyroidism became a commoner endocrine disease currently with a considerable case of asymptomatic individuals in contradiction of disease presentation 50 years ago (4).…”

“…Hyperparathyroidism became a commoner endocrine disease currently with a considerable case of asymptomatic individuals in contradiction of disease presentation 50 years ago (4). Therefore, the evolution of PHPTH from disease of bone and stone to an asymptomatic and identically finding disease is due to the widely available biochemical tests after introduction of routine serum calcium assessment by biochemistry auto-analyzers and more knowledge and notice of this disease (2). Some investigators even believe that the incidence of PHPTH is even 28 per 100,000 populaces, with a woman to man ratio of 2:1 with more frequency in postmenopausal females (5).…”