To evaluate the diagnostic performance of the calcium-chloride/phosphorus ratio (([Ca]×[Cl])/P) combined with alkaline phosphatase (ALP) in primary hyperparathyroidism (PHPT), specifically its subtypes—hypercalcemic PHPT (HPHPT) and normocalcemic PHPT (NPHPT)—for accurate clinical differentiation.
Key Findings:
Most PHPT patients were female, with higher adenoma prevalence in HPHPT (83.12%) than NPHPT (60.34%).
ALP, PTH, Ca/P, Cl/P, and ([Ca]×[Cl])/P levels were significantly elevated in HPHPT compared to NPHPT and controls (P<0.001).
The AUC for ([Ca]×[Cl])/P in diagnosing PHPT was 0.960; combined detection with ALP yielded an AUC of 0.983.
The AUC for differentiating HPHPT from NPHPT was 0.881, and for distinguishing adenomas from hyperplasia was 0.677.
Interpretation:
The combination of ([Ca]×[Cl])/P and ALP demonstrates favorable sensitivity and specificity for diagnosing PHPT and effectively differentiating its subtypes, highlighting its clinical utility.
Limitations:
The study is retrospective and conducted at a single center, which may limit generalizability.
Potential confounding factors were controlled for, but residual confounding cannot be entirely ruled out.
The single-center design may affect the applicability of the findings to broader populations.
Conclusion:
The combination of ([Ca]×[Cl])/P and ALP provides a practical diagnostic approach for PHPT and its subtypes.
