Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2026
ADOPTION OF THE FIFTH WORKSHOP URINARY CALCIUM THRESHOLD IN ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM.
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Castellano Elena, Boriano Alberto, Attanasio Roberto, Borretta Giorgio, Pia Anna
Аннотация
OBJECTIVE: The clinical presentation of sporadic primary hyperparathyroidism (PHPT) has shifted over the last decades towards an asymptomatic disease (aPHPT). International workshops have refined surgical criteria, and urinary calcium excretion (24h-UCa) has been among the most controversial parameters. Notably, 24h-UCa was the only modified criterion between the Fourth and Fifth Workshops. The threshold was lowered from a single cut-off of 400 mg/24h (Fourth Workshop) to gender-specific cut-offs of 300 mg/24h for males and 250 mg/24h for females (Fifth Workshop).
METHODS: We retrospectively analyzed our series of 540 patients with PHPT, focusing on the 225 patients with aPHPT and applying the surgical criteria dictated by the Fourth and Fifth International Workshops.
RESULTS: Patients with aPHPT who met the criteria for surgery increased from 186/225 (82.7%) to 199/225 (88.4%) by applying the Fourth and Fifth workshop criteria, respectively. The percentage of patients who exceeded the threshold for surgery according to the 24h-UCa criterion increased from 18.3% (34/186) to 45.2% (90/199), respectively. The percentage of those met only the 24h-UCa criterion increased from 8/186 (4.3%) to 13/199 (6.5%). Notably of the 39 patients with aPHPT who had not met any Fourth Workshop surgical criteria, 13 (33.3%) exceeded the new Fifth Workshop 24h-UCa threshold, thus newly qualifying for surgery.
CONCLUSIONS: Lowering the 24h-UCa threshold led to surgical reclassification in 13/39 patients (33.3%) with aPHPT who previously did not meet surgical indications. This revised criterion increased the overall proportion of patients meeting surgical criteria from 186/225 (82.7%) to 199/225 (88.4%), representing an absolute increase of 5.7% within the study cohort.
METHODS: We retrospectively analyzed our series of 540 patients with PHPT, focusing on the 225 patients with aPHPT and applying the surgical criteria dictated by the Fourth and Fifth International Workshops.
RESULTS: Patients with aPHPT who met the criteria for surgery increased from 186/225 (82.7%) to 199/225 (88.4%) by applying the Fourth and Fifth workshop criteria, respectively. The percentage of patients who exceeded the threshold for surgery according to the 24h-UCa criterion increased from 18.3% (34/186) to 45.2% (90/199), respectively. The percentage of those met only the 24h-UCa criterion increased from 8/186 (4.3%) to 13/199 (6.5%). Notably of the 39 patients with aPHPT who had not met any Fourth Workshop surgical criteria, 13 (33.3%) exceeded the new Fifth Workshop 24h-UCa threshold, thus newly qualifying for surgery.
CONCLUSIONS: Lowering the 24h-UCa threshold led to surgical reclassification in 13/39 patients (33.3%) with aPHPT who previously did not meet surgical indications. This revised criterion increased the overall proportion of patients meeting surgical criteria from 186/225 (82.7%) to 199/225 (88.4%), representing an absolute increase of 5.7% within the study cohort.