Thiazide-associated hypercalcemia

Incidence and association with primary hyperparathyroidism over two decades

Marcio L. Griebeler, Ann E. Kearns, Euijung Ryu, Prabin Thapa, Matthew A. Hathcock, L. Joseph Melton, Robert A. Wermers

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1166-1173
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume101
Issue number4
DOIs
StatePublished - Mar 1 2016

Fingerprint

Thiazides
Primary Hyperparathyroidism
Hypercalcemia
Incidence
Epidemiology
Clinical Laboratory Information Systems
Sodium Chloride Symporter Inhibitors
Parathyroidectomy
Antihypertensive Agents
Population
Osteoporosis
Screening
Information systems

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Thiazide-associated hypercalcemia : Incidence and association with primary hyperparathyroidism over two decades. / Griebeler, Marcio L.; Kearns, Ann E.; Ryu, Euijung; Thapa, Prabin; Hathcock, Matthew A.; Joseph Melton, L.; Wermers, Robert A.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 101, No. 4, 01.03.2016, p. 1166-1173.

Research output: Contribution to journalArticle

Griebeler, Marcio L. ; Kearns, Ann E. ; Ryu, Euijung ; Thapa, Prabin ; Hathcock, Matthew A. ; Joseph Melton, L. ; Wermers, Robert A. / Thiazide-associated hypercalcemia : Incidence and association with primary hyperparathyroidism over two decades. In: Journal of Clinical Endocrinology and Metabolism. 2016 ; Vol. 101, No. 4. pp. 1166-1173.
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abstract = "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.",
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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.

PY - 2016/3/1

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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.

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