Aim: To determine the frequency and characteristics of patients who received treatment for hyperparathyroid pathologies in the Mexico, San Juan de Dios and “Dr. Rafael Ángel Calderón Guardia” hospitals in a three-year period.

Methods: Analysis of records of high serum intact parathormone, medical records and bibliographical review. Descriptive study, whose sample was patients treated between January 2007 and December 2009. Determination of frequencies and proportions for the qualitative variables was made by means of the Chi-Square test. The quantitative variables were determined by the estimate of Student’s t-test.

Results: Out of 199 patients studied, 9 were excluded. Women prevailed (68.9 %), the most frequent age group was 60 years and over (33.1 %). Primary hyperparathyroidism was the most frequent disease (n=46, 24.2 %; 73.9 % women, 69.5% older than 50), then hypovitaminosis D and chronic renal failure. The majority lived in San José (59.4 %) and was assisted at the MexicoHospital (65.8%). There is no clear concept among some doctors, thus normocalcemic hyperparathyroidism is underestimated. The majority do not request determinations of vitamin D in these patients.

Discussion: Patients with raised PTH by diverse reasons are exposed to many diseases that can compromise their survival and quality of life. Hypovitaminosis D would probably be more frequent if measurement was requested more often. The request for calciphediol must be emphasized in any parathyroid disease.

Keywords: Hyperparathyroidism, PTH, parathormone, vitamin D.

^1,2 The main defense of the organism against hypercalcaemia is decreasing the secretion of PTH. This, will decrease the bone resorption and the kidney production of the active metabolite of vitamin D (VD), with the consequent decrease of intestinal absorption and increase urinary loss of calcium.² To address schematically hypercalcaemic disorders, a practical way is to establish the dependency and independency to PTH (table 1).³

⁴

⁵

iCa) and not by the total calcium; detected by calcium sensing receptors in the extracellular space. PTH is the major regulator of calcaemia, especially when changing from hypocalcaemia to normocalcaemia; however, some in vitro studies had proposed that this is not the only mechanism to maintain the serum calcium.^{7, 8}

²³ Several receptors, such as the calcium, the vitamin D and the fibroblastic growth factor receptors, mediate this system. There are other indirect actions on calcium and vitamin D receptors, with correlation dependence between calcium, calcitriol and phosphor. The serum ionized calcium in the parathyroid gland produces sigmoidal responses in PTH secretion: small calcium changes provoke great variations in PTH. An example can be seen when analyzing the independent variables.³ It is considered that in vivo, PTH different regulatory factors possessed interrelations that difficult the interpretation of each role separately.⁹

¹⁰ There are also reports of parathyroid carcinomas with normal serum levels of calcium. This cancer is an uncommon cause of hyperparathyroidism, and presents more frequently in severe hypercalcaemia and high levels of PTHi.¹¹

¹²

¹³

Costa Rica’s medical bibliography, as the first record of individuals with hyperparathyroid pathologies, and the relevance that possessed the serum measurement of vitamin D to define the diagnosis, and in other pathologies where the measurement of this hormone is essential.

Mexico, San Juan de Dios and “Dr. Rafael Ángel Calderón Guardia” Hospitals in a three year period (January 2007 to December 2009).

Costa Rica’s hospitals, is based in the file: “Clasificación estadística interna de enfermedades y problemas relacionados con la salud” (CIE-10) (Internal Statistic Classification of Diseases and Health-related problems), a work from PAHO (Pan American Health Organization).¹⁴

Mexico and “Dr. Rafael Ángel Calderón Guardia” Hospitals, a list of patients with elevated serum measurement of PTHi was selected. From the database of Hormone laboratory of San Juan de Dios Hospital, the list of patients with calcifediol serum determinations were from samples from the three hospitals mention above. The next step was to analyze the clinical files. The research forms were executed in the Excel software. A chronogram was elaborated from visits to hospitals, in pursuit of data from different hospital sections: File, Laboratory (Hormone and Clinical), and Biostatistics and from Outpatient Departments.

table 2).

table 2).

province of San José (59.4%), followed by Alajuela (17.3%). The majority of cases with primary hyperparathyroidism were also from San José (16.8%; table 3). In relation to the attending hospital of individuals with high PTHi, the majority were found in MexicoHospital (65.8%; table 4).

^15-17

Costa Rica’s social security hospitals, to the closure of the current study, is made only in one laboratory, located in San Juan de Dios hospital. The main cause is credited as it is an onerous reactive, but through the research course we found that many doctors don’t give importance to the necessity of requesting it, for the diagnosis of different pathologies. The report of normal levels of hormone allows clearing up and guiding a series of pathologies in the clinical practice. The early identification of individuals with hypovitaminosis D, associated with various parathyroid and non parathyroid pathologies, is essential. It can means favorable changes in the quality of life and the prognosis of different comorbidities in a large population group. Diagnosis of individuals with normocalcaemic hyperparathyroidism, without VD determination, translates into an erroneous concept about this pathology. The request of levels of calcifediol should be emphasized when approaching any parathyroid pathology.

Mexico hospital that would facilitate the search of information directed to these pathologies.

Costa Rica’s medical practice is based on the first national level study that registered the different causes of hyperparathyroidism, also the variables of the record and diagnosis approach, essential aspects to take into consideration to plan better strategies for management and treatment. During the research process, aseries of institutional weaknesses obstruct the search of a greater number of samples. It is recommended that more related researches of the pathologies associated with hyperparathyroidism should be made, principally due to the increasing reports on a national level, about deleterious effects, primarily on bone and cardiovascular morbidity and mortality that as an independent variable, means that individuals present high levels of serum PTHi.

Conflict of interest: The author declares no conflict of interest.