Symptoms of Primary Hyperparathyroidism in Men and Women: The Same but Different?

Introduction And Objective: Typical symptoms for primary hyperparathyroidism (pHPT) include osteoporosis, bone or joint pain, and nephrolithiasis, as well as fatigue, depression, gastritis, and cardiovascular disease. The female:male ratio was 3:1. The aim of this retrospective study was to evaluate the possible influence of gender-specific aspects of these symptoms.

Methods: From February 2018 to November 2019, parathyroid surgery was performed in 125 patients with pHPT (age: 23-83 years); 95 (76%) were female, and 30 (24%) were male. Preoperatively, a standardized medical history including 7 typical symptoms of pHPT was used for routine clinical documentation according to the StuDoQ Thyroid and Parathyroid Registry.

Results: For both groups (mean age: 60.4 years for females and 60.2 years for males), no sex differences were found in serum calcium or parathyroid hormone levels. For females, there was a tendency towards smaller hyperfunctioning parathyroid glands (16.8 vs. 20.5 mm) with less weight (1.14 vs. 1.52 g) and multiglandular disease. Nephrolithiasis was significantly more frequent in men than in women (36.7 vs. 16.8%, respectively; = 0.036), but the difference in hypertension was not significant (60% in men vs. 47.4% in women, = 0.230). Women reported significantly more often bone and joint pain (44.2% in women vs. 20% in men, = 0.053) and depressive episodes (32.6% in women vs. 10% in men, = 0.016).

Conclusion: 91.2% of patients transferred for parathyroidectomy described typical symptoms of pHPT. However, an unexpected high gender difference was found following the analysis of symptoms documented in the StuDoQ Registry.