Gender differences in the presentation, course and outcomes of primary hyperparathyroidism.

OBJECTIVE: To investigate gender-associated differences in the presentation, course, and outcomes of primary hyperparathyroidism (PHPT). STUDY DESIGN: A retrospective institutional cohort. METHODS: The database of a tertiary endocrine institute was retrospectively screened for patients treated for PHPT in 2010-2018. Clinical, biochemical, and imaging data were collected. Presentation, management, and outcome variables were compared by gender and by age at diagnosis (<50/≥50 years). RESULTS: The cohort included 182 women and 161 men diagnosed with PHPT at age 57.6 ± 12.8 and followed for 6.3 ± 5.5 years. There were no gender differences in age at detection of hypercalcemia and basal levels of serum and urinary calcium, serum PTH, and serum 25-hydroxyvitamin D. Men had a higher prevalence of nephrolithiasis (33 % vs 21 %, p = 0.01). Women had a higher frequency of osteoporosis (65 % vs 45 %, p < 0.001), and a lower mean lumbar spine T-score at PHPT diagnosis. At last follow-up, women had worse bone mineral density (BMD) results in all measured sites (lumbar spine, femoral neck, distal radius) and more fractures (34 % vs 20 %, p = 0.004), despite more frequent and longer pharmacological treatment of osteoporosis. On analysis by age, all these gender-associated differences were statistically significant only in patients diagnosed at age ≥50 years. Parathyroidectomy was performed in 52 % of women and 42 % of men (p = 0.06). CONCLUSION: The main differences between male and female patients with PHPT are the higher prevalence, more intensive pharmacological treatment, and worse outcomes of osteoporosis in women. Tailoring the optimal medical and/or surgical treatment for fracture prevention in patients with PHPT remains a major challenge, especially in older women.

Perceptions of gastroenterologists and nurses regarding irritable bowel syndrome and inflammatory bowel disease.

OBJECTIVE: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have similar symptoms, and both adversely affect patients' quality of life. The objective of this study was to compare the perceptions of physicians and nurses regarding IBS and IBD. METHODS: The Illness Perception Questionnaire Revised, adapted for medical staff, was sent at random to 300 physicians and nurses of gastroenterology departments and outpatient clinics nationwide to assess perceptions of IBS or IBD. Responses were statistically analyzed by illness and professional group. RESULTS: Fifty-five physicians and 43 nurses returned the questionnaire (response rate, 32.6%). Fifty-two questionnaires pertained to IBS and 46 to IBD. More physicians than nurses stated that the course of both illnesses does not improve over time (P<0.05). Both groups showed that medical treatment is of greater benefit for IBD than IBS (P<0.05) and that patients with IBD better understand their illness than patients with IBS (P<0.05). CONCLUSION: Physicians and nurses hold different attitudes to and perceptions of IBD and IBS in terms of chronicity, severity of the consequences, treatment efficacy, personal control, and illness coherence. These differences may have important effects on the patient-health provider relationship and should be addressed.