Genetic and clinical screening for hereditary primary hyperparathyroidism in a large Chinese cohort: a single-center study.

Primary hyperparathyroidism (PHPT) includes sporadic PHPT and hereditary PHPT. However, until now, there have been no exact data on the proportion and composition of hereditary PHPT in the Chinese PHPT population. This study aimed to clarify the proportion and composition of hereditary PHPT in patients at a large academic center in Beijing, China, and to analyze genotype-phenotype characteristics. A total of 394 newly diagnosed Han PHPT patients who consented to genetic screening were enrolled. Targeted next-generation sequencing (including for MEN1, RET, CDKN1B, CaSR, HRPT2/CDC73, GNA11, AP2S1, GCM2) combined with MEN1-MLPA and CDC73-MLPA were used for genetic screening. Diagnosis of hereditary PHPT was based on clinical manifestations, family history and genetic screening. Thirty-seven P/LP variants were detected in 41 patients via T-NGS, and three patients carried long-range deletions of MEN1 or CDC73 detected by MLPA, with a variant detection rate of 11.2% (44/394). In total, 30 patients were clinically diagnosed with MEN1. Combined with genetic and clinical screening, the rate of hereditary PHPT in this study was 18.8% (74/394). For purposes of comparison, the rate of unequivocal non-hereditary PHPT was 66.5% (262/394); 14.7% (58/394) who did not exhibit the clinical features of hereditary PHPT but carried VUS variants, thus, could not be clearly categorized. Both the age at hospital visit (43.6 ± 14.0 vs. 53.7 ± 14.9 years) and age at onset (35.4 ± 13.8 vs. 50.6 ± 14.8 years) in the hereditary group (n = 74) were significantly lower than those in the non-hereditary group (n = 262). A higher levels of ionized calcium and serum β-CTX were observed in the hereditary group; proportions of parathyroid hyperplasia and multigland involvement were also higher. In addition to multigland disease and positive family history, it is recommended that patients with an age of onset less than 38 should be screened for hereditary forms. This article is protected by copyright. All rights reserved.