A randomized-controlled study on the effects of loop- and thiazide-diuretics on the diurnal rhythms of calcitropic hormones and biochemical bone markers in postmenopausal womenHypercalcemia and primary hyperparathyroidism. The increase and subsequent decrease in the incidence of thiazide-associated hypercalcemia parallels the observed incidence of PHPT in Rochester (the central city of Olmsted County) during the same period (Ascertainment bias, due to targeted screening for hypercalcemia as part of a secondary osteoporosis evaluation, is the most likely explanation for the increase in the incidence of thiazide-associated hypercalcemia since 1998. The most appropriate management strategy for these patients remains unclear. Finally, given the unique record system in this community (Most endocrinological care in this community is provided by the Mayo Clinic, which has maintained a common medical record with its two hospitals for over 100 years. Most patients with thiazide-associated hypercalcemia are older (mean age, 67 years) and female (86%), which compares to 77% females and a mean age of 60 years in Rochester PHPT patients in 1998–2010.

Thiazide Treatment in Primary Hyperparathyroidism--a New Indication for an Old Medication. The overall annual age- and sex-adjusted incidence was 12.2 (95% CI, 10.6–13.8) per 100 000 (whites) incidence (per 100 000 person-years) of thiazide-associated hypercalcemia among Olmsted County, Minnesota, women (solid line) and men (dashed line), 1992–2010.whites) incidence (per 100 000 person-years) of thiazide-associated hypercalcemia among Olmsted County, Minnesota, women (solid line) and men (dashed line), 1992–2010.Incidence of Thiazide-Associated Hypercalcemia Among Olmsted County, Minnesota, Residents, 1992–2010, by Gender and Age GroupIncidence per 100 000 person-years directly age-adjusted to the United States white population in 2010.Incidence per 100 000 person-years directly age- and sex-adjusted to the United States white population in 2010.Incidence of Thiazide-Associated Hypercalcemia Among Olmsted County, Minnesota, Residents, 1992–2010, by Gender and Age GroupIncidence per 100 000 person-years directly age-adjusted to the United States white population in 2010.Incidence per 100 000 person-years directly age- and sex-adjusted to the United States white population in 2010.The mean age at diagnosis was 67.0 ± 11.3 years, and women comprised most cases (86.4%) (Clinical and Laboratory Spectrum of Thiazide-Associated Hypercalcemia Among Olmsted County, Minnesota, Residents 1992–2010, Overall and in a Subset Later Found to Have PHPTData are expressed as mean ± SD or number (percentage).Some patients had more than one reason for thiazide use.Clinical and Laboratory Spectrum of Thiazide-Associated Hypercalcemia Among Olmsted County, Minnesota, Residents 1992–2010, Overall and in a Subset Later Found to Have PHPTData are expressed as mean ± SD or number (percentage).Some patients had more than one reason for thiazide use.Thiazide therapy was discontinued in 83 patients (38%) an average of 85 months (range, 1.6 to 397 months) after thiazide initiation (Management and diagnostic profile of thiazide-associated hypercalcemia in Olmsted County, Minnesota, residents, 1992–2010.Management and diagnostic profile of thiazide-associated hypercalcemia in Olmsted County, Minnesota, residents, 1992–2010.Clinical and Laboratory Spectrum of Thiazide-Associated Hypercalcemia Among Olmsted County, Minnesota, Residents 1992–2010, Comparing Subsets Continuing and Discontinuing ThiazideAbbreviation: NS, not significant. J Clin Endocr Metab.

Thiazides are first-line treatment in essential hypertension and reduce mortality and cardiovascular events (1, 3).

Isaacs advocated that endocrinologists consider the following for their PHPT patients:Always consider surgery first. Thiazide Diuretics. Any reduction in blood pressure is maintained throughout the 24 hours by this once-a-day dose. Always consult your doctor about your medical conditions. Search for other works by this author on: Approach to the Treatment of a Patient with an Aggressive Pituitary Tumor “There are still plenty of other reports out there--in every textbook--that [thiazides] can cause problems.”Dr. Is there a risk of hypercalcemia for these patients?

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