Gender differences in the presentation, course and outcomes of primary hyperparathyroidism

Abstract Objective To investigate gender-associated differences in the presentation, course, and outcomes of primary hyperparathyroidism (PHPT). Study design A retrospective institutional cohort. Methods The database of a tertiary endocrine institute was retrospectively screened for patients treated for PHPT in 2010-2018. Clinical, biochemical, and imaging data were collected. Presentation, management, and outcome variables were compared by gender and by age at diagnosis ( Results The cohort included 182 women and 161 men diagnosed with PHPT at age 57.6 ± 12.8 and followed for 6.3 ± 5.5 years. There were no gender differences in age at detection of hypercalcemia and basal levels of serum and urinary calcium, serum PTH, and serum 25-hydroxyvitamin D. Men had a higher prevalence of nephrolithiasis (33% vs 21%, p = 0.01). Women had a higher frequency of osteoporosis (65% vs 45%, p  Conclusion The main differences between male and female patients with PHPT are the higher prevalence, more intensive pharmacological treatment, and worse outcomes of osteoporosis in women. Tailoring the optimal medical and/or surgical treatment for fracture prevention in patients with PHPT remains a major challenge, especially in older women.