Evaluation of the Thiazide Challenge Test to Differentiate Primary From Hypercalciuria-Related Hyperparathyroidism
Authors' conclusion
The TCT aids in discriminating patients with PHPT from those with SHPT-IH based on a rise in serum calcium. Other parameters are not different between both groups. Larger prospective trials are necessary to further define the diagnostic potential of the TCT, its most appropriate biochemical outcome variables, and decision cut-offs.
Study context
- Population
- Adults with hypercalciuria, elevated parathyroid hormone (PTH) and high-normal or elevated serum calcium; outpatient Endocrinology, Ghent University Hospital (Belgium), January 2017 to November 2023
- Participants
- 25 adults
- Exposure
- Thiazide challenge test: Primary hyperparathyroidism (PHPT) vs SHPT-IH
- Outcome
- Change in albumin-adjusted calcium after TCT
Methodological detailsmonocentric, observational
- Monocentric
- Observational
Main finding
As reported in the abstract
PHPT
+0.11
± 0.10 · mmol/L
SHPT-IH
+0.0071
± 0.10 · mmol/L
P = 0.025
Observational data: associations, not effects.
Further findings
| Outcome | PHPT | SHPT-IH | P value |
|---|---|---|---|
| Change in total serum calcium after TCTGreater increase with PHPT | +0.14 ± 0.12 mmol/L | +0.012 ± 0.15 mmol/L | P = 0.024 |
- Accuracy of thiazide challenge test (TCT)-based working diagnosis of PHPT for correct final diagnosis
- 81.8% · sensitivity · specificity 77.8% · likelihood ratio 3.68
Urinary calcium excretion, PTH, calcium-phosphorous ratio, PTH inhibition rate, parathyroid function index
- Did not differ significantly in PHPT vs SHPT-IH
Original publication
Evaluation of the Thiazide Challenge Test to Differentiate Primary From Hypercalciuria-Related Hyperparathyroidism. J Clin Endocrinol Metab. Published 12 April 2024. doi:10.
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