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Prevalence of Monoclonal Gammopathy in Patients With Primary Hyperparathyroidism
A Prospective Study
Bertrand Arnulf, MD;
Djaouida Bengoufa, MD;
Emile Sarfati, MD;
Marie-Elisabeth Toubert, MD;
Véronique Meignin, MD;
Jean-Claude Brouet, MD, PhD;
Jean-Paul Fermand, MD
Arch Intern Med. 2002;162:464-467.
Background The association between primary hyperparathyroidism (PHPT) and monoclonal
gammopathy has been reported, but whether it is fortuitous remains unsettled.
We conducted a prospective study to determine the prevalence of monoclonal
gammopathies in patients with surgically proved PHPT.
Methods In 101 consecutive patients with PHPT, serum immunoglobulins were systematically
studied using agarose gel electrophoresis and immunofixation before and, when
appropriate, after parathyroid surgery. The PHPT population was compared with
a control series of patients with other diseases requiring surgery and with
a group of patients with benign disease of the thyroid gland matched for age
and sex to the PHPT population.
Results Monoclonal immunoglobulin was detected in 10 (10%) of 101 patients with
PHPT (including 2 with multiple myeloma) compared with 2 (2%) of 127 patients
who underwent other surgery (P = .005) and 3 (3%)
of 101 patients with benign thyroid diseases (P =
.04).
Conclusions The prevalence of monoclonal gammopathies is high in patients with PHPT.
At minimum, sensitive serum protein electrophoresis should be performed routinely
in all patients with PHPT. Conversely, in patients with monoclonal gammopathy
who have hypercalcemia but no other symptoms of progressive disease, clinicians
must seek PHPT.
From the Service d'Immuno-Hématologie (Drs Arnulf, Brouet, and
Fermand), Laboratoire d'Immuno-Histocompatibilité (Dr Bengoufa), Service
de Chirurgie Viscérale (Dr Sarfati), Service de Médecine Nucléaire
(Dr Toubert), and Service d'Anatomopathologie (Dr Meignin), Hôpital
Saint-Louis, Paris, France.
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