• Mustapha El Lakis, Pavel Nockel, Apostolos Gaitanidis, Bin Guan, Sunita Agarwal, James Welch, William F Simonds, Lee Weinstein, Stephen Marx, Naris Nilubol, Dhaval Patel, Roxanne Merkel, Amit Tirosh, and Electron Kebebew.
• Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
• J. Am. Coll. Surg. 2018 May 1; 226 (5): 933-938.

BackgroundApproximately 10% of patients with primary hyperparathyroidism (PHPT) have hereditary disease. Hereditary PHPT may be syndromic (MEN1, 2, and 4 and hyperparathyroidism-jaw tumor syndrome) or non-syndromic (familial isolated PHPT). There are limited data on the probability of testing positive for genetic mutation based on clinical presentation. The aim of this study was to determine potential associations between clinical and biochemical features and mutation in susceptibility genes for PHPT in patients with a family history of PHPT.Study DesignA retrospective analysis of 657 patients who had an initial parathyroidectomy for PHPT at a tertiary referral center. Logistic regression analyses were performed in 205 patients with a family history of PHPT to identify factors associated with a positive genetic test.ResultsOf 657 patients, 205 (31.2%) had a family history of PHPT. Of those 205 patients, 123 (60%) had a germline mutation detected (91 MEN1, 14 CDC73, and 18 GCM2). In univariate analysis, younger age (45 years and younger), male sex, multigland disease, and parathyroid carcinoma were associated with positive germline mutation; biochemical cure after an initial parathyroidectomy was less frequent in patients with familial PHPT (96.2% vs 89.2%; p = 0.005). In multivariable analysis, age 45 years and younger, male sex, and multigland disease were independent factors associated with positive genetic testing.ConclusionsIn addition to a family history of PHPT, male sex, age 45 years and younger, and presence of multigland disease, should prompt physicians to offer the opportunity for genetic counseling and testing, as it could influence the management of patients with PHPT.Published by Elsevier Inc.

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