Just when we thought there was a chink of hope for wider recognition in the UK of Normocalcemic Primary Hyperparathyroidism upon hearing that BAETS hosted a webinar on NCPHPT, we found out that the astonishing rumour of the upper bracket of normal range PTH levels being raised are actually TRUE!
We have yet to find out who has sanctioned this devious and highly unethical change. The outcome, of course, is that even fewer people will be diagnosed with normocalcemic primary hyperparathyroidism. Despite published studies dating back as far as 1969 stating the cardiac and skeletal risks of normocalcemic PHPT are equal to or greater than hypercalcemic PHPT patients, they will be further denied a diagnosis and parathyroidectomy. and left to suffer the often excruciating symptoms of kidney stones and shattered bones. If anybody knows who sanctioned this increase to 11.00pmol/L, please do let me know. You can read the reactions of some of our members on Twitter by following me; @SpSallie
If 'they' decided to increase the upper level of blood sugar to reduce the incidences of diabetes, people would be up in arms about it. People should be up in arms about this cruel prejudiced tactic also.
Here are a few studies about the risks of normocalcemic primary hyperparathyroidism; 'Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism;https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1093-4?fbclid=IwAR3yi5CLaZE7yKREb7clDIhdaLefhjYAbEjElAALmetmUYtbgDc6u4dkl0E#citeas
'High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism'; https://www.karger.com/Article/Abstract/502578 'Patients seen in a referral centre with normocalcemic hyperparathyroidism have more substantial skeletal involvement than is typical in PHPT and develop more features and complications over time'; https://academic.oup.com/jcem/article/92/8/3001/2597709
NCPHT is NOT a new phenotype. See this study from 1975; https://www.surgjournal.com/article/0039-6060(75)90057-4/fulltext
'In normocalcemic patients, parathyroidectomy is as safe and effective as in hypercalcemic patients'; https://link.springer.com/article/10.1007/s00423-018-1659-0
'Early intervention for this group with mild PHPT may prevent progression of bone, psychiatric, and renal complications'; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153463/?fbclid=IwAR0U6qZLpN7UHKYkOjW7myEQ_6%20ebP37WE3uxk5C7B1Zd1n8knMZ9U5jtV9c
Ignoring the term 'mild' in the article above, we relate more to this statement; 'Since the only difference is in terms of bone resorption parameters, in most cases it seems to be an attenuated form or even similar to the classical presentation'; https://www.sciencedirect.com/science/article/abs/pii/S0002961019309390
'Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism; https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1093-4?fbclid=IwAR1L4FcgIJGeTSMqC0euUMPCgKGi5TS5tdT2JUBx1if4iR9VIvLiAGAjGvg#citeas
We have plenty more where they came from.
Sallie Powell