SAT0396 High Frequency of Asymptomatic Primary Hyperparathyroidism in Patients with Fibromyalgia: A Fortuitous Association or a Misdiagnosis?
Authors: J. M. D. F. Trindade, A. Ranzolin, C. A. D. C. da Costa Neto, C. D. L. Marques, A. L. B. P. Duarte
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Fibromyalgia (FM) and primary hyperparathyroidism (PHPT) are diseases that can present similar symptoms such as musculoskeletal pain, cognitive impairment, nonrefreshing sleep, depression and anxiety, and thus, cause diagnostic confusion. <h3>Objectives</h3> To determine the frequency of asymptomatic PHPT in patients with FM and to evaluate the association of laboratory findings with clinical symptoms. <h3>Methods</h3> A cross-sectional study was conducted which included 100 women diagnosed with FM as per the criteria of the American College of Rheumatology (ACR - 1990 and 2010) and 57 healthy women, to whom dosages of parathyroid hormone (PTH), calcium and albumin were taken in addition to which a survey of the clinical symptomatology was made in the FM group <h3>Results</h3> The mean age in both groups was similar (46.8 years old in the FM group and 42.1 in the comparison group, p=0.185). The mean value NTP of calcium in the FM group was 12.3 mg/dL and the PTH was 133.9 pg/ml, these being significantly higher than in the comparison group, where the value of calcium was 9.4 mg/dL and that of PTH was 52.2 pg/ml (p&lt;0.001 for both values). Hypercalcemic PHPT was diagnosed in 6% of FM patients, and 17% presented only high PTH, which characterizes normocalcemic PHP. There was no statistically significant association of PTH levels and calcium with FM symptoms, with the exception of epigastric pain, which was more frequent in the group of patients with PHPT and FM (p=0.012). <h3>Conclusions</h3> There is a high frequency of PHPT in FM patients compared with healthy women. Future studies are needed to assess whether this is just a random association, whether the increases in PTH serum are part of the physiopathology of FM or even whether, should they not be cases of FM, they may be cases of asymptomatic PHPT. <h3>References</h3> Silverberg SJ. Non-classical target organs in primary hyperparathyroidism. J Bone Miner Res. 2002 Nov;17 Suppl 2:N117-25. Farnebo LO. Primary hyperparathyroidism. Update on pathophysiology, clinical presentation and surgical treatment. Scand J Surg. 2004;93(4):282-7. Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. J Clin EndocriNol Metab. 2009 Feb;94(2):351-65. Coker LH, Rorie K, Cantley L, Kirkland K, Stump D, Burbank N, et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg. 2005 Nov;242(5):642-50. Okamoto T, Kamo T, Obara T. Outcome study of psychological distress and Nonspecific symptoms in patients with mild primary hyperparathyroidism. Arch Surg. 2002 Jul;137(7):779-83; discussion 84. Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004 Apr 22;350(17):1746-51. <h3>Disclosure of Interest</h3> None Declared