Batna Journal of Medical Sciences
Volume 13, Numéro 6, Pages 423-428
2026-07-01
The Hidden Burden Of Asymptomatic Primary Hyperparathyroidism: Renal And Bone Complications In Incidentally Diagnosed Patients
Authors : Khalouf Mohamed Abderaouf . Seridj Nardjess . Rabehi Leyla . Boudjella Mohamed Lotfi . Louddani Abir . Hamoudi Djamila . Rabehi Hassan .
Abstract
Background: Primary hyperparathyroidism (PHPT) is increasingly diagnosed incidentally through routine biochemical screening. However, a critical question remains: is incidentally discovered PHPT truly asymptomatic, or does it already cause subclinical renal and bone damage? This study aimed to quantify the hidden burden of incidentally discovered PHPT by comparing clinical, biochemical, and complication profiles with symptomatic PHPT. Methods: Retrospective cohort study of 166 consecutive patients who underwent parathyroidectomy for PHPT between 2019 and 2025 at a tertiary referral center in Algeria. Patients were classified as incidental (n=103, 62%; no classical symptoms) or symptomatic (n=63, 38%). Preoperative PTH, calcium, vitamin D, renal lithiasis, bone mineral density (including distal radius), fractures, and surgical outcomes were compared. Multivariate logistic regression identified predictors of symptomatic presentation using SPSS v26. Results: Among incidentally discovered patients – who had no classical symptoms – a substantial proportion already exhibited target organ damage: 28% had renal lithiasis, 32% had osteoporosis, and the mean distal radius T score was –1.8 SD. Compared to symptomatic patients, incidental patients had significantly lower PTH (median 125 vs 210 ng/L, p<0.001), lower calcium (115±12 vs 128±15 mg/L, p=0.002), and higher vitamin D (20.5±9.0 vs 14.5±7.5 ng/mL, p<0.001). However, the prevalence of osteoporosis was only 20 percentage points lower (32% vs 52%), and renal lithiasis was only 20 percentage points lower (28% vs 48%). In other words, one in three incidental patients already had osteoporosis, and one in four already had kidney stones. Surgical success was 94% in both groups. Conclusion: Incidentally discovered (asymptomatic) PHPT is not a benign condition. A substantial proportion of patients already have significant renal and bone complications at diagnosis. These findings argue against a purely observational approach and support routine biochemical screening to enable earlier diagnosis and timely surgical intervention before irreversible complications occur.
Keywords
Primary hyperparathyroidism ; incidental diagnosis ; asymptomatic ; osteoporosis ; nephrolithiasis ; parathyroidectomy
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