Original articles
Primary hyperparathyroidism detected in a health screening: The Tromsø Study

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Abstract

Serum calcium was measured in 12,339 men and 13,394 women ages 25 to 75. Primary hyperparathyroidism, defined as a combination of serum calcium and parathyroid hormone (PTH) levels within the extreme or upper normal range, was diagnosed in 17 men and 47 women. The prevalence in both sexes increased with age. When 42 subjects with asymptomatic primary hyperparathyroidism were followed for 3 years, no significant increase in serum calcium or PTH was seen. In a subgroup of 473 men and 517 women ages 50 to 75, serum PTH was measured along with serum calcium. Depending on the criteria used to define primary hyperparathyroidism, the prevalence in older women within this subgroup ranged from 3.6% to 13.9%. The study concluded that a high prevalence of primary hyperparathyroidism exists in older women, although the progression of the disease, judging by serum calcium and PTH measurements, appears to be very slow.

Introduction

Primary hyperparathyroidism is diagnosed by demonstrating an inappropriately increased level of parathyroid hormone (PTH) in relation to that of serum calcium [1]. However, in larger population-based health surveys which included screening for primary hyperparathyroidism, the diagnosis has mainly been based on serum calcium measurements alone, since reliable assays for PTH were not available. Thus, for example, in a health screening from 1969 in Gävle, Sweden, which included more than 16,000 subjects, the prevalence of hypercalcaemia in the total population was found to be 0.7%, increasing to over 3% in women above the age of 60 [2]. Similarly, in a study from Stockholm in 1973 where some 21,000 subjects were screened, the prevalence was found to be 0.3% of the total population, increasing to 1.3% in older women [3]. This pattern has been confirmed in several hospital-based studies; there is now general agreement that the incidence of primary hyperparathyroidism is higher in women than men, and that it increases with age 4, 5.

In Tromsø, Norway, a large health survey was performed on more than 27,000 inhabitants during 1994–1995. Serum calcium was measured in all subjects, and those with levels above 2.59 mmol/L were re-examined. PTH was also measured in a subgroup of 990 subjects, thus affording an opportunity of determining the prevalence of primary hyperparathyroidism by a variety of criteria for its definition.

Section snippets

Subjects and definitions

The Tromsø study is a broad health survey first instituted in Norway in 1974. It is carried out by the National Health Screening Service in co-operation with the University of Tromsø and local health authorities. The present study is based on the fourth survey (1994–1995). A total of 12,866 men and 14,293 women participated, representing 74.2% and 79.0% of the eligible population, respectively. All subjects had blood samples drawn for serum calcium measurements. If serum calcium was ⩾2.60

Main study group: serum calcium measured during screening

Because only individuals below the age of 76 were included in the follow-up study, those above that age do not appear in the presentation below. The total number of subjects, therefore, comprised 12,339 men and 13,394 women.

Discussion

The present study indicates the increased prevalence of primary hyperparathyroidism in women, particularly those above the age of 70. Depending on the screening method and definition of primary hyperparathyroidism employed, the prevalence in this group ranged from 1.75% to 13.9%, underscoring the role consensus plays in the identification of this disease.

In attempting to diagnose primary hyperparathyroidism, it will be recalled that about 50% of total serum calcium exists in a free or ionized

Acknowledgements

The present study was supported by a grant from the Norwegian Research Council.

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