Primary hyperparathyroidism in Saudi Arabia revisited: a multi-centre observational study

Abstract

Purpose Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia and remains understudied within the Arabian population. The present study, the largest of its kind within the Gulf Cooperation Council (GCC) countries, aims to determine the demographics and clinical presentation of PHPT in Saudi Arabia. Methods In this multi-center retrospective study involving three tertiary hospitals in different geographic locations of Saudi Arabia namely, Riyadh, Al Ahsa and Jeddah, a total of 205 out of 243 confirmed PHPT cases aged 16 to 93 years old were included (N = 96 from Riyadh; N = 59 from Al Ahsa and N = 50 from Jeddah). Demographics, clinical manifestations and surgical outcomes were recorded as well as laboratory and radiologic investigations including serum parathyroid hormone (PTH), 25(OH)D, adjusted calcium, estimated glomerular filtration rate (eGFR) and nuclear scan outcome. Results PHPT cases appeared to increase over time when compared to other local studies published so far, with 12.8 cases per 100,000 hospital population. Females outnumber males (3:1) with 86% seen as out-patients. The average age was 59.8 ± 15.5 years. Abnormal PTH scan was seen in 171 patients (83.4%). Kidney stones was the most common renal manifestation (32 cases, 15.6%) and osteoporosis was the most common skeletal manifestation (67 cases, 32.7%). Al Ahsa had the highest prevalence of multiple comorbidities at 54% and the highest prevalence of obesity as a single comorbidity (17%) compared to other regions (p < 0.05). Jeddah recorded the highest prevalence of osteoporosis with bone and joint pains (30%) (p < 0.05). Conclusion Comparison of present data with previous local studies suggest an increasing trend in PHPT cases in Saudi Arabia. Regional variations in the clinical presentation of PHPT were observed and warrant further investigation.

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

“…As reported in other studies (16, [20][21][22], nephrolithiasis was the most common presenting feature; the prevalence of osteoporosis was lower compared with studies reporting similar rates of symptomatic PHPT (5,6,16,21,22) and may be explained by less frequent screening for hypercalcaemia at primary levels of care.…”

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

“…As reported in other studies [ 16 , 20 – 22 ], nephrolithiasis was the most common presenting feature; the prevalence of osteoporosis was lower compared with studies reporting similar rates of symptomatic PHPT [ 5 , 6 , 16 , 21 , 22 ] and may be explained by less frequent screening for hypercalcaemia at primary levels of care.…”

Clinical, Biochemical and Surgical Outcomes of Primary Hyperparathyroidism in the Present Era: A Prospective Study From a Tertiary Care Hospital

“…The average age of presentation in the current study was 42 years. Two recent studies from Asia have reported a mean age of 56 and 59 years [ 10 , 11 ]. Our patients continue to be much younger than patients from developed countries and other Asian countries [ 12 ].…”

“…However, despite the relatively low prevalence of abnormalities detected in routine X-rays, bone densitometry by DEXA revealed osteoporosis in over one-third of the patients, highlighting the detrimental skeletal effects of PHPT. Two recent studies from Asia have documented osteoporosis in 32.7% and 50% of patients [ 10 , 11 ]. Commonly reported gastrointestinal manifestations are recurrent pain in the abdomen, constipation, heartburn, nausea, and anorexia, which occur in about 45%, 33%, 30%, 20%, and 15% of cases, respectively [ 21 ].…”