Objectives: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography. Methods: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows. Results: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<0.05) and osteocalcin. Conclusions: Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients. These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.
Objetivo: La relación hiperparatiroidismo-litiasis renal es bien conocida y el estudio de paratiroides es obligado en paciente con litiasis, sobre todo si hay recidivas. Nuestro objetivo es analizar los casos de HPTP con litiasis renal y su evolución tras paratiroidectomía; estudiar los factores que se asocian a la presencia de litiasis o patología ósea y revisión bibliográfica. Métodos: Estudio descriptivo retrospectivo de una serie de 287 casos de hiperparatiroidismo: 237 primarios, 50 hiperparatiroidismos secundarios. Hemos analizado: sexo, edad, tiempo de evolución, clínica, pruebas diagnósticas (bioquímicas, radiológicas e histológicas). En pacientes con clínica de litiasis se ha analizado el número de episodios previos al diagnóstico y su tratamiento, si presentaban litiasis residual tras el tratamiento del cálculo, si sufrieron episodios posteriores a la paratiroidectomía y si fueron tratados o no. Análisis estadístico con SPSS 15.0 para Windows. Resultados: El 45% de pacientes había presentado episodios de litiasis, 50% osteopenia/osteoporosis, 23% algias osteomusculares, astenia y/o síndrome depresivo el 23%; en el 13,5% de los casos el diagnóstico se realiza tras el hallazgo de hipercalcemia sin otros síntomas. Analizamos factores favorecedores o inhibidores de formación de litiasis renal, hemos comparado parámetros bioquímicos del grupo de hiperparatiroidismos primarios con litiasis (41 pacientes) con grupo sin litiasis (49). Observamos que enfermos con litiasis presentan cifras más elevadas de calcio, fosfatasa alcalina, PTHi, PTHm, osteocalcina, índice cloro/fosfato, calciuria y fosfaturia. Al aplicar el test "t" Student para dos muestras independientes se encontraron diferencias estadísticamente significativas en niveles de calcio (p<0,05), PTHi (p<0,05) y osteocalcina. Conclusiones: Los casos de hiperparatiroidismo primario con litiasis presentan cifras de calcio, para-thormona, fosfatasa alcalina, osteocalcina, índice Cl/P y calciuria más elevadas que los pacientes con HPTP sin litiasis. Estos pacientes presentan mejoría objetiva de síntomas tras paratiroidectomía, es poco frecuente la recurrencia de litiasis, que generalmente coincide con la persistencia de litiasis residual