CHARACTERISTICS OF PATIENTS SURGICALLY TREATED FOR PRIMARY HYPERPARATHYROIDISM WITH AND WITHOUT RENAL STONES

Background. Between 1980 and 1984, 312 (30%) of 1038 patients undergoi ng initial cervical exploration for primary hyperparathyroidism (pHPT) at our institution has proven renal stones. Methods. In this retrospe ctive study we focused on clinical characteristics, biochemical tests, perioperative and pathologic findings, and immediate outcomes of oper ation, comparing findings in patients with and without renal stones. R esults. Patients with renal stones were more often younger male patien ts, had serum phosphorus levels significantly lower (p < 0.02) and 24- hour urinary calcium excretion significantly higher (p < 0.0001) than patients without renal stones, and had a significantly higher (p < 0.0 5) proportion of abnormal glands weighing less than 250 mg. Relevant d iagnostic preoperative variables were evaluated by means of multivaria te analysis to determine whether they independently had predictive pow er with regard to renal stones. Male gender and younger age were signi ficantly associated with the presence of renal stones, providing odds ratios of 2.5 and 1.4, respectively. In addition, the risk of having r enal stones was significantly related to minimally elevated serum calc ium levels (p < 0.05), serum phosphorus levels (p = 0.02), and 24-hour urine calcium excretion (p < 0.05). Conclusions. In patients with ren al stones the diagnosis of pHPT should be considered. If the diagnosis is confirmed, a liberal approach to cervical exploration should be ta ken.