Primary Hyperparathyroidism: Experience from a Tertiary Care Centre in Pakistan

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2020 Sep 24

PMID 32968380

Citations 2

Authors

Tehseen Fatima

Bhagwan Das

Saadia Sattar

Najmul Islam

Affiliations

Soon will be listed here.

Abstract

Objective: To study the clinical, biochemical and radiological features and management outcomes of patients with primary hyperparathyroidism.

Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan and comprised data of patients with primary hyperparathyroidism from 2008 to 2017.

Results: Out of 103 patients, 83(80.6%) were female. Overall mean age was 59.3±16.2 years. Musculoskeletal manifestations were seen in 60(58.3%) patients and renal manifestations in 28(27.2%). Ostieits fibrosa cystica was found in 04(3.88%) patients. Overall, Ultrasound neck and sestamibi scan localized the lesion in 66 (64.1%) and 77 (76.2%) patients respectively. Among 79 patients who underwent surgery, 67 (84.8%) patients had an adenoma, 05 (6.3%) had hyperplasia and 02(2.53%) patients had parathyroid carcinoma whereas histopathology was inconclusive in 5 (6.32%) out of the 79 surgically treated patients. Disease recurrence was seen in 13 out of 79(16.45%) patients who underwent surgery.

Conclusion: Primary hyperparathyroidism is associated with significant morbidity in our population. Targeted measures like improving patient awareness, routine calcium screening, vitamin D supplementation and a high index of suspicion by the clinician may help in early diagnosis of the condition and thus reduce morbidity.

Citing Articles

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Malignant and Non-Malignant Causes of Hypercalcemia: A Retrospective Study at a Tertiary Care Hospital in Pakistan.

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References

Moline J, Eng C . Multiple endocrine neoplasia type 2: an overview. Genet Med. 2011; 13(9):755-64. DOI: 10.1097/GIM.0b013e318216cc6d. View

Bilezikian J, Khan A, Potts Jr J . Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009; 94(2):335-9. PMC: 3214274. DOI: 10.1210/jc.2008-1763. View

Meng L, Liu S, Al-Dayyeni A, Sheng Z, Zhou Z, Wang X . Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha. Int J Endocrinol. 2018; 2018:6282687. PMC: 6186333. DOI: 10.1155/2018/6282687. View

Wermers R, Khosla S, Atkinson E, Achenbach S, Oberg A, Grant C . Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993-2001: an update on the changing epidemiology of the disease. J Bone Miner Res. 2005; 21(1):171-7. DOI: 10.1359/JBMR.050910. View

Mishra S, Agarwal G, Kar D, Gupta S, Mithal A, Rastad J . Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg. 2001; 88(5):708-14. DOI: 10.1046/j.0007-1323.2001.01775.x. View

Marques T, Vasconcelos R, Diniz E, Rego D, Griz L, Bandeira F . Normocalcemic primary hyperparathyroidism in clinical practice: an indolent condition or a silent threat?. Arq Bras Endocrinol Metabol. 2011; 55(5):314-7. PMC: 4357231. DOI: 10.1590/s0004-27302011000500003. View

Bala S, Shah B, Rajput P, Rao P . Unmasking of primary hyperparathyroidism by Vitamin D therapy. Indian J Nephrol. 2015; 25(6):377-9. PMC: 4663778. DOI: 10.4103/0971-4065.157427. View

Pradeep P, Jayashree B, Mishra A, Mishra S . Systematic review of primary hyperparathyroidism in India: the past, present, and the future trends. Int J Endocrinol. 2011; 2011:921814. PMC: 3124672. DOI: 10.1155/2011/921814. View

Charopoulos I, Tournis S, Trovas G, Raptou P, Kaldrymides P, Skarandavos G . Effect of primary hyperparathyroidism on volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in postmenopausal women. J Clin Endocrinol Metab. 2006; 91(5):1748-53. DOI: 10.1210/jc.2005-2102. View

10.

Biyabani S, Talati J . Bone and renal stone disease in patients operated for primary hyperparathyroidism in Pakistan: is the pattern of disease different from the west?. J Pak Med Assoc. 2000; 49(8):194-8. View

11.

Adami S, Marcocci C, Gatti D . Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res. 2002; 17 Suppl 2:N18-23. View

12.

Watts N, Bilezikian J, Camacho P, Greenspan S, Harris S, Hodgson S . American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract. 2011; 16 Suppl 3:1-37. PMC: 4876714. DOI: 10.4158/ep.16.s3.1. View

13.

Bhadada S, Arya A, Mukhopadhyay S, Khadgawat R, Sukumar S, Lodha S . Primary hyperparathyroidism: insights from the Indian PHPT registry. J Bone Miner Metab. 2017; 36(2):238-245. DOI: 10.1007/s00774-017-0833-8. View

14.

Afzal A, Gauhar T, Butt W, Khawaja A, Azim K . Management of hyperparathyroidism: a five year surgical experience. J Pak Med Assoc. 2012; 61(12):1194-8. View

15.

Tordjman K, Greenman Y, Osher E, Shenkerman G, Stern N . Characterization of normocalcemic primary hyperparathyroidism. Am J Med. 2004; 117(11):861-3. DOI: 10.1016/j.amjmed.2004.06.037. View

16.

Bilezikian J, Rubin M, Silverberg S . Asymptomatic primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2006; 50(4):647-56. DOI: 10.1590/s0004-27302006000400010. View

17.

Garcia-Martin A, Reyes-Garcia R, Munoz-Torres M . Normocalcemic primary hyperparathyroidism: one-year follow-up in one hundred postmenopausal women. Endocrine. 2012; 42(3):764-6. DOI: 10.1007/s12020-012-9694-z. View

18.

Mazeh H, Sippel R, Chen H . The role of gender in primary hyperparathyroidism: same disease, different presentation. Ann Surg Oncol. 2012; 19(9):2958-62. DOI: 10.1245/s10434-012-2378-3. View

19.

Ahsan T, Erum U, Inam Pal K, Jabeen R, Qureeshi S, Rehman U . The many guises of primary hyperparathyroidism: An unchanged scenario. J Pak Med Assoc. 2017; 67(4):580-585. View

20.

Yeh M, Ituarte P, Zhou H, Nishimoto S, Liu I, Harari A . Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013; 98(3):1122-9. PMC: 3590475. DOI: 10.1210/jc.2012-4022. View