Clinical and laboratory profile of primary hyperparathyroidism in Kashmir Valley: A single-center experience

Abstract

Background:Although primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the West, in India, PHPT is still an uncommonly diagnosed, overtly symptomatic disease with skeletal, muscular, and renal manifestations.Aims:To describe the profile and surgical outcome of 78 consecutive PHPT patients over a period of two decades at a single center.Materials and Methods:All patients who underwent evaluation and surgery for PHPT from January 1996 to December 2015 were included. Evaluation included measurement of serum total calcium, inorganic phosphorus, alkaline phosphatase, intact parathyroid hormone, 25-hydroxy Vitamin D, 24 hour urinary calcium and radiological survey. Ultrasonography neck and technetium-99m sestamibi scan were used for preoperative localization.Results:A total of 78 patients were identified during the two decades of whom 29 patients were studied retrospectively and 49 patients prospectively. Mean age of patients was 44.72 ± 12.46, and male:female ratio was 1:6. The most common presenting features were nephrolithiasis and/or nephrocalcinosis (64.10%), bone pain (44.1%), abdominal pain (39%), constipation (26%), and myopathy (14.10%). Fractures were present only in 10.25%, and brown tumors in 6.41% patients. The cure rate in our series was 96.15%. The mean parathyroid gland weight was 2.05 ± 3.03 g. None of the 41 patients in whom long-term follow-up was available, had recurrence of PHPT.Conclusions:The profile of PHPT is changing with older age at presentation, and emergence of renal stone disease and decline in overt skeletal disease as common presentation. The parathyroid weight in our study resembles that reported from developed countries.

Five-year retrospective study on primary hyperparathyroidism in South India: Emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography-computed tomography scan

“…This is in contrast with the studies done in other parts of India where renal stones were present in up to 65%–70% of patients as part of initial presentation. [ 16 19 ] Our data are similar to the data from developed countries where the initial presentation with renal stones has receded in the recent years and more asymptomatic cases are detected. [ 22 23 ] This finding could probably be explained as we had a significant number of asymptomatic patients and our cohort of patients probably underwent routine biochemical evaluation more frequently than people from other parts of India.…”

“…[ 13 ] and Misgar et al . [ 19 ] The mean phosphorous level in our study was 2.43 ± 0.7 mg/dl which was slightly lesser than the mean phosphorous level of 2.8 ± 0.9 mg/dL in the Indian Parathyroid Registry. [ 16 ]…”

“…[ 16 17 18 ] In one study from Kashmir, the mean age of patients at presentation was 44.72 ± 12.46 years which matches with our data probably because 62% of patients in that study were enrolled after 2012. [ 19 ] The reason why PHPT presents at a younger age in our country is possibly because of the associated Vitamin D deficiency. However, in the study from Kashmir, the mean 25(OH) D levels were surprisingly good.…”

“…[ 24 ] Probable mechanisms of pancreatitis include hypercalcemia-induced activation of trypsinogen to trypsin, ductal obstruction due to pancreatic calculi, and genetic risk factors. [ 19 ] There are case reports of recurrent episodes of pancreatitis in patients with PHPT. [ 25 ] In a Indian study which looked at the gastrointestinal manifestations of PHPT, abdominal pain (43%) was the most common presenting feature followed by constipation (36%) and nausea (22%), and in the same study, 22% of patients had a history of gall stones with an increased incidence of pancreatitis in men and gallstone disease in women.…”

Management and outcomes of hyperparathyroidism: a case series from a single institution over two decades

“…In this study cohort, the mean age of patients was 49.4±15 years which is in agreement with earlier reports from Western countries. 14 It has been noted that patients in the developing countries tend to be younger and symptomatic at their first presentation. 15 , 16 We also observed female predominance which is in line with the current literature.…”