TY - JOUR
T1 - Thiazide-associated hypercalcemia
T2 - Incidence and association with primary hyperparathyroidism over two decades
AU - Griebeler, Marcio L.
AU - Kearns, Ann E.
AU - Ryu, Euijung
AU - Thapa, Prabin
AU - Hathcock, Matthew A.
AU - Joseph Melton, L.
AU - Wermers, Robert A.
N1 - Publisher Copyright:
© 2016 by the Endocrine Society.
PY - 2016/3
Y1 - 2016/3
N2 - Context: Thiazide diuretics, the antihypertensive agent prescribed most frequently worldwide, are commonly associated with hypercalcemia. However, the epidemiology and clinical features are poorly understood. Objective: To update the incidence of thiazide-associated hypercalcemia and clarify its clinical features. Patients and Methods: In a population-based descriptive study, Olmsted County, Minnesota, residents with thiazide-associated hypercalcemia were identified through the Rochester Epidemiology Project and the Mayo Clinic Laboratory Information System from 2002-2010 and were added to the historical cohort beginning in 1992. Main Outcome: Incidence rates were adjusted to the 2010 United States white population. Results: Overall, 221 Olmsted County residents were identified with thiazide-associated hypercalcemia an average of 5.2 years after initiation of treatment. Subjects were older (mean age, 67 years) and primarily women (86.4%). The incidence of thiazide-associated hypercalcemia increased after 1997 and peaked in 2006 with an annual incidence of 20 per 100 000, compared to an overall rate of 12 per 100 000 in 1992-2010. Severe hypercalcemia was not observed in the cohort despite continuation of thiazide treatment in 62.4%. Of patients discontinuing thiazides, 71% continued to have hypercalcemia. Primary hyperparathyroidism was diagnosed in 53 patients (24%), including five patients who underwent parathyroidectomy without thiazide discontinuation. Conclusions: Many patients with thiazide-associated hypercalcemia have underlying primary hyperparathyroidism. Additionally, a sharp rise in thiazide-associated hypercalcemia incidencebegan in 1998, paralleling the increase observed in primary hyperparathyroidism in this community. Case ascertainment bias from targeted osteoporosis screening is the most likely explanation.
AB - Context: Thiazide diuretics, the antihypertensive agent prescribed most frequently worldwide, are commonly associated with hypercalcemia. However, the epidemiology and clinical features are poorly understood. Objective: To update the incidence of thiazide-associated hypercalcemia and clarify its clinical features. Patients and Methods: In a population-based descriptive study, Olmsted County, Minnesota, residents with thiazide-associated hypercalcemia were identified through the Rochester Epidemiology Project and the Mayo Clinic Laboratory Information System from 2002-2010 and were added to the historical cohort beginning in 1992. Main Outcome: Incidence rates were adjusted to the 2010 United States white population. Results: Overall, 221 Olmsted County residents were identified with thiazide-associated hypercalcemia an average of 5.2 years after initiation of treatment. Subjects were older (mean age, 67 years) and primarily women (86.4%). The incidence of thiazide-associated hypercalcemia increased after 1997 and peaked in 2006 with an annual incidence of 20 per 100 000, compared to an overall rate of 12 per 100 000 in 1992-2010. Severe hypercalcemia was not observed in the cohort despite continuation of thiazide treatment in 62.4%. Of patients discontinuing thiazides, 71% continued to have hypercalcemia. Primary hyperparathyroidism was diagnosed in 53 patients (24%), including five patients who underwent parathyroidectomy without thiazide discontinuation. Conclusions: Many patients with thiazide-associated hypercalcemia have underlying primary hyperparathyroidism. Additionally, a sharp rise in thiazide-associated hypercalcemia incidencebegan in 1998, paralleling the increase observed in primary hyperparathyroidism in this community. Case ascertainment bias from targeted osteoporosis screening is the most likely explanation.
UR - http://www.scopus.com/inward/record.url?scp=84960851843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960851843&partnerID=8YFLogxK
U2 - 10.1210/jc.2015-3964
DO - 10.1210/jc.2015-3964
M3 - Article
C2 - 26751196
AN - SCOPUS:84960851843
SN - 0021-972X
VL - 101
SP - 1166
EP - 1173
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 3
ER -