PRIMARY HYPERPARATHYROIDISM IN PATIENTS WHO HAVE, RECEIVED RADIATION-THERAPY AND IN PATIENTS WHO HAVE, NOT RECEIVED RADIATION-THERAPY

BACKGROUND: Primary hyperparathyroidism (HPT) occurs more frequently i n persons who have been exposed to low-dose therapeutic radiation. Lit tle information is available concerning whether or not the clinical, m etabolic, and pathologic manifestations, as well as outcome, differ in these patients when com pared with patients with sporadic HPT. STUDY DESIGN: Records from 438 unselected patients with primary HPT, who wer e treated from 1982 to 1993 were retrospectively analyzed. Ah patients prospectively received a standard questionnaire preoperatively and po stoperatively concerning clinical manifestations and a history of radi ation exposure. Forty-nine patients had a history of radiation exposur e (rHPT), whereas 389 did not have sporadic HPT (sHPT). RESULTS: There was no difference in gender (36 women and 13 men versus 289 women and 100 men) or age (mean of 52+/-12 versus 57+/-16 years) in patients wi th rHPT or sHPT. Fatigue, neuropsychiatric disorders, memory loss, noc turia, and polyurea were more common in patients with sHPT (p<0.05), w hereas pain in joints was more common in patients with rHPT (63 versus 52 percent; p<0.001). Serum calcium levels were similar (11.1+/-0.8 v ersus 11.2+/-0.8 mg per dL), but serum parathyroid hormone levels were higher in rHPT (448+/-14 percent of upper limit of normal versus 371/-12 percent upper limit of normal). The parathyroid pathology was sim ilar in the two groups (single adenoma 74 versus 72 percent, hyperplas ia 14 versus 16 percent, and double adenoma 12 versus 12 percent in rH PT versus sHPT, respectively), Thyroid pathology was more common in th e rHPT group (multinodular goiter 27 versus 7 percent and papillary th yroid carcinoma 14 versus 0.3 percent). Seven (1.8 percent) of patient s not receiving radiation therapy treated by us had persistent HPT, bu t no patients receiving or not receiving radiation therapy had recurre nt HPT during the follow-up period (six years). CONCLUSIONS: Patients who have HPT after radiation treatment have more thyroid neoplasms but are otherwise quite similar to other patients with primary hyperparat hyroidism.