Primary hyperparathyroidism in India: A cocktail of contemporary and classical presentations: Lesson from 47 cases

Maskey, Robin; Panchani, Roopal; Varma, Tarun; Goyal, Ashutosh

doi:10.4103/2230-8210.119574

Cited by 10 publications

(14 citation statements)

References 9 publications

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“…This might be particularly useful especially in laboratory/medical settings relying on limited resources, in which PTH determination is difficult or not possible. In this regard the use of the Ca/P ratio for the diagnosis of PHPT can be extended to every clinical and laboratory setting worldwide, including developing countries, reducing health inequalities due to limited access to diagnostic facilities, such as hormone measurements . Thanks to its simplicity, the Ca/P ratio could be useful in clinical settings characterized by large inflow of patients (eg, general practitioner, emergency room, PHPT screening of osteoporotic patients).…”

Section: Discussionmentioning

confidence: 99%

“…In this regard the use of the Ca/P ratio for the diagnosis of PHPT can be extended to every clinical and laboratory setting worldwide, including developing countries, reducing health inequalities (40) due to limited access to diagnostic facilities, such as hormone measurements. (41,42) Thanks to its simplicity, the Ca/P ratio could be useful in clinical settings characterized by large inflow of patients (eg, general practitioner, emergency room, PHPT screening of osteoporotic patients). In all these conditions Ca/P may perform very well, allowing cost savings and selecting patients as candidates for second-line diagnostic procedures such as PTH assay and imaging.…”

Section: Discussionmentioning

confidence: 99%

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Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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Primary hyperparathyroidism (PHPT) diagnosis is challenging and is based on serum calcium (Ca) and parathyroid hormone (PTH). Because serum Ca and phosphorous (P) are inversely related in PHPT, we investigated the diagnostic value of the serum Ca/P ratio in the diagnosis of PHPT. We report a single‐center, case‐controlled, retrospective study including 97 patients with documented PHPT and compared them with those of 96 controls (C). The main outcome measures were: serum PTH, 25‐OH vitamin D, Ca, P, albumin, and creatinine. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the serum Ca/P ratio were calculated. The results were verified using an independent, anonymous set of data extracted from a laboratory database containing over 900 million entries. A total of 35 (36.1%) PHPT patients had normocalcemic PHPT (NCHPT). Ca and PTH were significantly higher in PHPT than in C (p < 0.0001). P was significantly lower in PHPT than in C (p < 0.0001). The Ca/P ratio was significantly higher in PHPT than in C (p < 0.0001). Receiver‐operating characteristic (ROC) curves analyses identified a cutoff of 2.71 (3.5 if Ca and P are expressed in mg/dL) for Ca/P ratio with a sensitivity and specificity of 86% and 87%, respectively (p < 0.0001), confirmed by the independent, big data approach. In conclusion, Ca/P is a valuable tool for the diagnosis of PHPT and is of superior value compared to serum Ca alone, especially in NCPHT. Because Ca/P is simple, inexpensive, and easily accessible worldwide, this ratio is useful for PHPT diagnosis, especially in laboratory/medical settings relying on limited resources, such as low‐income countries. © 2017 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

et al. 2017

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“…Other studies from different parts of India show a higher female preponderance with female to male ratio ranging from 2:1 to 6:1. 5,6,[14][15][16][17][18][19][20][21][22][23][24] The incidence in hyperparathyroidism is typically described in the sixth decade. 3 In our study, 55.5% of the patients were less than 40 years and 18.5% were younger than 20 years (mean 39±16.7).…”

Section: Discussionmentioning

confidence: 99%

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

2019

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Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p<0.05.Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution.

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“…The typical pentad of ''bones, stones, moans,groans and fatigue overtones'' may be visible in variable proportions [9]. Generalized weakness, anemia, abdominal pain because of gastric ulcer, pancreatitis, renal or gall bladder stones are common features.…”

Section: Discussionmentioning

confidence: 99%

Giant Cell Lesions Associated with Primary Hyperparathyroidism

Rai

Rattan

Bhadada

2014

J. Maxillofac. Oral Surg.

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Aims and Objective To evaluate the prevalence, clinical features, diagnostic laboratory values and treatment outcome of giant cell lesions (brown tumors) associated with primary hyperparathyroidism (PHPT) in oral and maxillofacial region. Study Design A 5 year retrospective data was analyzed wherein all histopathologically proven cases of giant cell lesions involving oral and maxillofacial region were evaluated. Out of these cases, those associated with PHPT were tabulated. Correlation was established with other concomitant clinical features and also with the laboratory values of altered serum calcium, phosphate, alkaline phosphate and parathormone. Follow up of these cases after the correction of PHPT was also noted. Result Out of 85 cases of histopathologically proven giant cell lesions, five cases were associated with PHPT. There was involvement of maxilla and mandible in one case each. Only frontal bone was involved in two cases. Fifth case had multiple lytic lesions in maxilla and frontal bone. All patients consistently showed very high values of alkaline phosphate and parathormone. Hypercalcemia and hypophosphatemia was noted in four cases. All cases showed regression of the lytic lesion after parathyroidectomy obviating the need for surgical excision of the jaw lesions.Conclusion Giant cell lesions (brown tumors) associated with PHPT in oral and maxillofacial region are rare clinical entities. The prevalence of PHPT associated giant cell lesions is 5.9 %. They are clinically, radiologically and histopathologically similar to any other peripheral or central giant cell tumor. Relevant history may alert the clinician and altered biochemical values may help in correlating the oral and maxillofacial findings with the underlying systemic disease. At times, the brown tumor maybe the only presenting sign leading to the diagnosis of PHPT.

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Primary hyperparathyroidism in India: A cocktail of contemporary and classical presentations: Lesson from 47 cases

Cited by 10 publications

References 9 publications

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Serum Calcium to Phosphorous (Ca/P) Ratio Is a Simple, Inexpensive, and Accurate Tool in the Diagnosis of Primary Hyperparathyroidism

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

Giant Cell Lesions Associated with Primary Hyperparathyroidism

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