Is There Any Connection Between the Presence of Kidney Stones in Primary Hyperparathyroidism and the Location of an Underlying Adenoma?

Abstract

The majority of the patients with primary hyperparathyroidism (pHPT) recurrently produce kidney stones, while the rest have other clinical manifestations. The aim of this study was to examine the possibility of an association between the presence of kidney stones and the location of an underlying adenoma. This was a retrospective evaluation of the records of 91 patients (10 males, 81 females, mean age: 61.9 years [20 - 70 yrs]) operated for primary hyperparathyroidism between 1995 and 2000. One patient was excluded due to carcinoma. Kidney stones were found in 55 cases and other clinical symptoms in 35 cases. In 50 of the 55 patients (91 %) with kidney stones, the adenoma was located in the left inferior parathyroid gland (chi2 = 67.5, p < 0.00,001), while in 24 of the 35 patients (69 %) without kidney stones, the adenoma was in the right inferior parathyroid gland (chi2 = 43.9, p < 0.0001). These results suggest that the location of the adenoma may influence the presence of kidney stones in pHPT. It is proposed that the biologic effects of parathyroid hormone could differ depending on which of the four parathyroid glands it was secreted in, or the four glands may produce different biologically active fragments.

Clinical and laboratory characteristics of calcium stone‐formers with and without primary hyperparathyroidism

“…Using values for the urinary calcium to creatinine ratio, and serum calcium and creatinine concentrations [10] Csupor et al. found 3.3% FECa in HPT, vs the present value of 1.92%.…”

“…[9] found a mean of 10.9 mg/dL in 27 cases, Csupor et al. [10] found a mean of 12 mg/dL among 55 cases. The weighted mean for all 338 cases, excluding those of Mallette et al.…”

“…For example, Csupor et al. [10] reported a mean ( sd ) PTH of 186 (196), meaning many values must have been near normal (<65). Levy et al.…”

Oral calcium supplementation associated with decreased likelihood of nephrolithiasis prior to surgery for hyperparathyroidism

“…Their series of 90 patients with surgically treated PHPT showed that 91% of those with kidney stones had adenomas in the left inferior parathyroid gland, and 69% of those without kidney stones had adenomas in the right inferior gland. They suggested that perhaps distinct active PTH fragments may be made from different parathyroid glands 10 . They did not, however, speculate regarding the autonomous versus suppressible nature of the adenomas based on location in the neck, nor did they analyze patients with hyperplasia rather than adenoma.…”

“…They suggested that perhaps distinct active PTH fragments may be made from different parathyroid glands. 10 They did not, however, speculate regarding the autonomous versus suppressible nature of the adenomas based on location in the neck, nor did they analyze patients with hyperplasia rather than adenoma.…”