Application of an integral scale for diagnosing primary hyperparathyroidism with an assessment of the probability of disease development: a case report

To improve the efficacy of primary hyperparathyroidism (PHPT) diagnosis and probability assessment, we developed the “Automated System for the Diagnosis of Primary Hyperparathyroidism and Dynamic Assessment of Phosphorus–Calcium Metabolism (PHPTCalculator),” which was tested at the Samara State Medical University clinics. During validation, the PHPTCalculator correctly diagnosed PHPT in all 68 patients, which was subsequently confirmed by surgical findings.

Here, we present a 47yearold male patient (R.) who presented with dizziness, weakness, and joint pain. Ultrasound revealed a right parathyroid adenoma and left parathyroid hyperplasia. Before surgery, the PHPTCalculator estimated the probability of PHPT at 100%. The patient underwent selective parathyroidectomy with removal of the lower parathyroid glands. Histopathology confirmed a chiefcell parathyroid adenoma. Three months after surgery, joint pain persisted, and parathyroid hormone (PTH) was 78 pg/mL. Although ultrasound and scintigraphy showed no abnormal parathyroid glands, the PHPTCalculator estimated the probability at 75%. The patient underwent a second surgery: bilateral neck exploration and removal of the upper hyperplastic parathyroid gland. Histopathology again confirmed a chiefcell parathyroid adenoma. Three months after the second surgery, the patient was asymptomatic, and the estimated probability was 25%, supported by normalization of PTH, total and ionized calcium, and serum phosphorus.

Thus, the proposed PHPT diagnostic scale showed high diagnostic value and may serve as an additional diagnostic tool in this patient population.