Clinical endocrinology · 2025
Biochemical Ratios for Predicting Primary Hyperparathyroidism: Revisiting Simple yet Powerful Diagnostic Tools.
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Şah Ünal Fatma Tuğçe, Demir Özgür, Emral Rıfat, Gökçay Canpolat Asena
Аннотация
PURPOSE: Differentiating primary hyperparathyroidism (PHPT), normocalcemic PHPT (NPHPT), and vitamin D deficiency-related secondary hyperparathyroidism (VDSHPT) remains a diagnostic challenge. This study evaluated the utility of biochemical markers in distinguishing these conditions.
METHODS: In this cross-sectional study, 437 participants were categorised into PHPT (n = 161), NPHPT (n = 97), VDSHPT (n = 89), and control (n = 90) groups. Serum calcium, phosphate, chloride, PTH, and vitamin D levels were analysed, along with indices such as Ca/P, Cl/P, Ca × Cl/P, and the PF Index (Ca × PTH/P).
RESULTS: Calcium levels were highest in PHPT (2.73 ± 0.17 mmol/L), while phosphate levels were lowest (0.70 ± 0.19 mmol/L) both p < 0.001. PTH levels were significantly elevated in PHPT, NPHPT, and VDSHPT versus controls (p < 0.001). Ca/P ratio was significantly higher in PHPT (4.17 ± 1.21, p < 0.001), as was the Ca × Cl/P ratio (448.5 ± 133.6, p < 0.001). No significant difference was found between NPHPT and VDSHPT groups in Ca/P (p = 0.63) and Ca × Cl/P (p = 0.74) ratios. Ca × Cl/P ratio exhibited the highest diagnostic accuracy for PHPT with a specificity of 89.2% and PPV of 82.2%. Ca/P ratio had the highest sensitivity (77.6%) and an NPV of 86.6%. PF Index (AUC: 0.851, 95% CI: 0.816-0.886) and Cl/P ratio (0.766, 95% CI: 0.711-0.820) showed moderate accuracy. In NPHPT, all markers had high sensitivity but poor specificity (1.6%-23.2%).
CONCLUSION: The Ca × Cl/P and Ca/P ratios demonstrate substantial diagnostic value for PHPT, while biochemical markers exhibited limited specificity in NPHPT. These findings highlight their role in screening but emphasize the need for additional diagnostic approaches.
METHODS: In this cross-sectional study, 437 participants were categorised into PHPT (n = 161), NPHPT (n = 97), VDSHPT (n = 89), and control (n = 90) groups. Serum calcium, phosphate, chloride, PTH, and vitamin D levels were analysed, along with indices such as Ca/P, Cl/P, Ca × Cl/P, and the PF Index (Ca × PTH/P).
RESULTS: Calcium levels were highest in PHPT (2.73 ± 0.17 mmol/L), while phosphate levels were lowest (0.70 ± 0.19 mmol/L) both p < 0.001. PTH levels were significantly elevated in PHPT, NPHPT, and VDSHPT versus controls (p < 0.001). Ca/P ratio was significantly higher in PHPT (4.17 ± 1.21, p < 0.001), as was the Ca × Cl/P ratio (448.5 ± 133.6, p < 0.001). No significant difference was found between NPHPT and VDSHPT groups in Ca/P (p = 0.63) and Ca × Cl/P (p = 0.74) ratios. Ca × Cl/P ratio exhibited the highest diagnostic accuracy for PHPT with a specificity of 89.2% and PPV of 82.2%. Ca/P ratio had the highest sensitivity (77.6%) and an NPV of 86.6%. PF Index (AUC: 0.851, 95% CI: 0.816-0.886) and Cl/P ratio (0.766, 95% CI: 0.711-0.820) showed moderate accuracy. In NPHPT, all markers had high sensitivity but poor specificity (1.6%-23.2%).
CONCLUSION: The Ca × Cl/P and Ca/P ratios demonstrate substantial diagnostic value for PHPT, while biochemical markers exhibited limited specificity in NPHPT. These findings highlight their role in screening but emphasize the need for additional diagnostic approaches.