Primary hyperparathyroidism in north India: a description of 52 cases

Abstract

BACKGROUNDPrimary hyperparathyroidism (PHPT) has a variable clinical expression. Symptomatic PHPT is still the predominant form of the disease in many parts of the world, especially developing countries. Because the clinical profile of the disease has changed from that described in the past, we sought to improve our understanding of the disease in patients in north India.METHODSWe summarized the clinical presentation, biochemical and radiological features, and operative findings from the case records from the last 13 years of 52 patients at a tertiary care centre in north India who had documented PHPT.RESULTSThe male: female ratio was 1: 3.3 with ages ranging from 6 to 60 years (mean±SD, 36.38±12.73). Bone disease (46%), recurrent renal stones (21%) and body aches and pains (21%) were the most common modes of presentation. The lag time varied ranged from 1 month to 16 years. Common clinical manifestations included bone pain (67%), weakness/fatigue (56%), fracture of the long bones (48%), abdominal pain (39%), polyuria (37%) and psychiatric manifestations (23.1%). Hypertension was observed in 42% and a palpable nodule in the neck in 19%. Biochemical features included hypercalcemia (86.5%), hypophosphatemia (65.4%) and hyperphosphatasia (67.3%). Mean intact PTH (±SD) was 809.0±696.3 ng/L with levels significantly lower in patients who had only kidney stone disease as compared with those with bone disease (P=0.017). A single parathyroid adenoma was localized in 50 (98%) patients. Hungry bone disease was seen in 59% patients.CONCLUSIONPHPT in India continues to be a symptomatic disorder with skeletal and renal manifestations at a much younger age.

Simultaneous expression analysis of vitamin D receptor, calcium-sensing receptor, cyclin D1, and PTH in symptomatic primary hyperparathyroidism in Asian Indians

“…The major clinical manifestation in our patient group was bone pain and more than half of our patients had bone involvement. Our previous study (24) and a recent publication from China (28) have also shown that PHPT is still symptomatic with bone manifestations in this part of the world.…”

“…unlike the mostly asymptomatic nature of presentation in the West (24). Accordingly, we examined the expression of VDR, CASR, CD1, and PTH using immunohistochemistry and confirmed with mRNA analyses in a cohort of parathyroid adenomas from Asian Indian patients with symptomatic PHPT.…”

“…However, very little is known about such abnormalities in adenomas from patients with symptomatic sporadic PHPT (24,25,26).…”

Unique Clinical Characteristics of Primary Hyperparathyroidism and Role of Nuclear Medicine Imaging

“…Technetium-99 pertechnetate subtraction has been reported to have a sensitivity of 87-100% [12,14,15] . Contrast-enhanced computerized tomography (CECT) of the neck has a sensitivity ranging from 65% to 93.5% in localizing parathyroid adenoma [12,13,14] .…”

“…Neck ultrasound (USG) has been reported to localize the adenoma in 65-77% of patients [12,13,14] . Methyl isobutyl isonitrile (MIBI) scan positivity has been reported in 86.9-100% [14,15] .…”