# Trends in Clinical Features of Primary Hyperparathyroidism During 2013–2024

## TL;DR

The study shows that clinical features of primary hyperparathyroidism in China have changed over time, with more asymptomatic cases and milder symptoms in recent years.

## Contribution

The study provides new insights into the evolving clinical patterns of PHPT in China using a large cohort.

## Key findings

- Asymptomatic PHPT cases increased significantly between 2013–2024 with milder clinical manifestations.
- Symptomatic patients showed higher PTH and calcium levels compared to asymptomatic patients.
- Benign parathyroid tumors were most common, while malignant tumors showed distinct biochemical markers.

## Abstract

Clinical features of primary hyperparathyroidism (PHPT) differ between developed and developing countries. In past decades, patterns of PHPT have changed while there are currently few data on large cohorts in Chinese. Therefore, this study aims to describe changes in clinical features of Chinese patients with PHPT.

685 patients with PHPT were collected and divided into several subgroups by time periods, symptoms, and pathological types. Clinical characteristics were compared among subgroups.

Patients were divided into 177 cases (25.8%) in group A (2013–2018) and 508 cases (74.2%) in group B (2019–2024). Compared with group A, parathyroid hormone (PTH) was significantly lower and clinical manifestations were milder, and the percentage of asymptomatic patients was higher in group B. Bone pain (46.8%), nephrolithiasis (37.3%), and fatigue (36.2%) were the most common symptoms in symptomatic patients. Serum PTH, calcium, osteocalcin, and urine pH levels in symptomatic patients were higher than those in asymptomatic patients, while serum phosphate and bone density levels were lower. In addition, among 417 surgical patients, benign parathyroid tumor was in 373 cases (89.4%), atypical parathyroid tumor was in 34 cases (8.2%), and parathyroid carcinoma was in 10 cases (2.4%). Compared with benign PHPT, serum PTH, calcium, alkaline phosphatase, and bone turnover marker (BTM) levels were significantly increased, and serum phosphate level was decreased in malignant PHPT.

Clinical features of PHPT changed during 2013–2024 with remarkably increasing asymptomatic PHPT patients, whose clinical manifestations were milder, and complications were less.