Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Hypercalcemia affects from 7% up to 18% of patients with sarcoidosis. Primary hyperparathyroidism (PHPTH) along with malignancies are responsible for most cases with hypercalcemia. We aim to determine rates of primary hyperparathyroidism in patients with Sarcoidosis and survival benefits of controlling it.
Methods: We conducted a retrospective cohort study using the TriNetX clinical research platform, representing data from over 120 million patients across the US collaborative network. Our study aimed to investigate the coexistence of primary hyperparathyroidism (PHPT) in patients with sarcoidosis. We analyzed data from 117,395 patients with sarcoidosis, categorizing them based on their calcium levels (normal or high) and parathyroid hormone (PTH) levels (normal or high). The study assessed several key outcomes: the rate of proper hypercalcemia workup, the prevalence of PHPT, the frequency of parathyroidectomy procedures, and mortality rates across different patient groups. For each outcome, we calculated hazard ratios with 95% confidence intervals to compare risks between groups and subgroups. This comprehensive analysis allowed us to evaluate the rates of PHTP in patients with sarcoidosis and impact of hypercalcemia and PHPT on mortality, as well as the effects of PTX.
Results: The study cohort of 117,395 patients had a mean age of 56.4 ± 14 years, with 57.6% females. Hypercalcemia was observed in 31.3% (36,790) of patients, but only 30.5% (11,217) of these patients with hypercalcemia received PTH assessment. Among those with both hypercalcemia and PTH assessment, 50% (5,615) were diagnosed with primary hyperparathyroidism (PHPT). However, only 6.5% (362) of PHPT patients underwent parathyroidectomy (PTX). Over a median 3-year follow-up, hypercalcemia is associated with increased mortality risk by 33% compared to normal calcium levels (HR: 1.33; 95% CI: 1.29 – 1.38). PHPT was associated with 50% higher mortality compared to patients without PHPT (HR: 1.5; 95% CI: 1.4 – 1.6). Notably, patients with PHPT who did not undergo PTX had a 4-fold increase in mortality compared to those who received PTX (HR: 4.2; 95% CI: 2.7 – 6.4).
Conclusion: Our study reveals significant under-evaluation and under-treatment of hypercalcemia in patients with sarcoidosis. This leads to missed PHPT diagnoses and a significant increase in mortality. We recommend thorough hypercalcemia workup, including PTH assessment, for all patients with sarcoidosis with elevated calcium levels. Timely referral for parathyroidectomy in confirmed PHPT cases could significantly improve survival outcomes.