African Americans present with more severe primary hyperparathyroidism than non-African Americans

Background: Similar to other disease states, we postulated that African American patients present with more severe signs of primary hyperparathyroidism than non-African Americans. To test this hypothesis, we compared relevant preoperative laboratory values, sestamibi scan results, and intraoperative findings between African American and non-African American patients with primary hyperparathyroidism who underwent parathyroidectomy between January 2002 and May 2007. Methods: In all, 588 patients were included and 113 (19%) were African American. A linear model was used to examine the effect of race with respect to mean differences in serum calcium, 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH), alkaline phosphatase (ALKP) levels, gland weight, presence of double adenomas and, sestamibi scan sensitivity. Results: Adjusted for age and gender, African Americans exhibited significantly higher median calcium (11.36 [SD = 0.91] vs 11.06 [SD = 0.72] mg/dL, P < .001), iPTH (138.5 [SD = 166.03] vs 117 [73.22] pg/mL, P < .01), and ALKP (101 [SD = 57.86] vs 90.5 [SD = 29.78] U/L, P < .01) levels compared with non- African Americans. They exhibited significantly lower median serum 25(OH)D (14 [SD = 9.36] vs 23 [SD = 12.160] ng/mL, P < .001), greater gland weight (P < .001), a higher probability of double adenomas (odds ratio = 2.83, 95% confidence interval [CI], 1.36-5.88), and a higher probability of presenting with a positive sestamibi scan (odds ratio = 4.99, 95% CI = 2.44-10.19) compared with non-African Americans. Conclusion: African Americans present with more advanced signs of primary hyperparathyroidism than non-African Americans. These results may reflect less access to health care, surgical consultations, or other unidentified factors. These highly significant findings, however, warrant additional investigation.