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Summary   Objective  There is limited knowledge about the natural history of normocalcaemic, vitamin D‐sufficient hyperparathyroidism ( nHPT ). The aim was to study the prevalence of  nHPT  and its relation to morbidity.    Design  Cross‐sectional and retrospective study at the Sahlgrenska University Hospital, Gothenburg, Sweden.    Subjects  A random population of 608 men and women, age 25–64 years, was studied in 1995 as part of the  WHO MONICA  study and reinvestigated in 2008 ( n  = 410, of whom 277 were vitamin D sufficient).    Measurements  A serum intact parathyroid hormone (S‐ PTH ) ≥60 ng/l was considered as  HPT , S‐calcium 2·15–2·49 mmol/l as normocalcaemia and S‐25( OH )D ≥ 50 nmol/l as vitamin D sufficiency. Data on fractures, stroke and myocardial infarction were retrieved until 2013, that is a 17‐year follow‐up.    Results  The prevalence of  nHPT  was 2·0% in 1995 (age 25–64) and 11·0% in 2008 (age 38–79). S‐ PTH  was positively correlated with age and  BMI . After adjustment for these variables, a high S‐ PTH  level (≥60 ng/l) at follow‐up was associated with previously low S‐25( OH )D, high osteocalcin, S‐ PTH  and both past and presently treated hypertension. No relation was seen with creatinine, cystatin C, malabsorption markers, thyroid function, glucose, insulin, lipids, calcaneal quantitative ultrasound, fractures, myocardial infarction, stroke or death at follow‐up.    Conclusions  This small random population study showed that  nHPT  was common, 11% at follow‐up. Only one individual developed mild hypercalcaemia in 13 years. Previous S‐ PTH  was predictive of  nHPT  and hypertension was prevalent, but no increase in hard end‐points was seen over a 17‐year period.

clinical endocrinology

Normocalcaemic, vitamin D‐sufficient hyperparathyroidism – high prevalence and low morbidity in the general population: A long‐term follow‐up study, the  WHO MONICA  project, Gothenburg, Sweden