Gender differences in the presentation, course and outcomes of primary hyperparathyroidism

Tal Dadon, Gloria Tsvetov*, Sigal Levi, Alexander Gorshtein, Ilana Slutzky-Shraga, Dania Hirsch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: To investigate gender-associated differences in the presentation, course, and outcomes of primary hyperparathyroidism (PHPT). Study design: A retrospective institutional cohort. Methods: The database of a tertiary endocrine institute was retrospectively screened for patients treated for PHPT in 2010–2018. Clinical, biochemical, and imaging data were collected. Presentation, management, and outcome variables were compared by gender and by age at diagnosis (<50/≥50 years). Results: The cohort included 182 women and 161 men diagnosed with PHPT at age 57.6 ± 12.8 and followed for 6.3 ± 5.5 years. There were no gender differences in age at detection of hypercalcemia and basal levels of serum and urinary calcium, serum PTH, and serum 25-hydroxyvitamin D. Men had a higher prevalence of nephrolithiasis (33 % vs 21 %, p = 0.01). Women had a higher frequency of osteoporosis (65 % vs 45 %, p < 0.001), and a lower mean lumbar spine T-score at PHPT diagnosis. At last follow-up, women had worse bone mineral density (BMD) results in all measured sites (lumbar spine, femoral neck, distal radius) and more fractures (34 % vs 20 %, p = 0.004), despite more frequent and longer pharmacological treatment of osteoporosis. On analysis by age, all these gender-associated differences were statistically significant only in patients diagnosed at age ≥50 years. Parathyroidectomy was performed in 52 % of women and 42 % of men (p = 0.06). Conclusion: The main differences between male and female patients with PHPT are the higher prevalence, more intensive pharmacological treatment, and worse outcomes of osteoporosis in women. Tailoring the optimal medical and/or surgical treatment for fracture prevention in patients with PHPT remains a major challenge, especially in older women.

Original languageEnglish
Pages (from-to)12-17
Number of pages6
StatePublished - Mar 2021


  • Gender-biased medicine
  • Hypercalcemia
  • Nephrolithiasis
  • Osteoporosis
  • Parathyroid hormone (PTH)
  • Primary hyperparathyroidism (PHPT)


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