Endocrine Abstracts

Background: The most common etiology of hypercalcemia is primary hyperparathyroidism (PHPT). PHPT is a disorder of calcium, phosphorus and bone metabolism secondary to uncontrolled increased parathyroid hormone secretion. PHPT has a variable clinical expression. Symptomatic PHPT is still the predominant form of the disease in many parts of the World, especially in developing countries.

Methods: We summarized the clinical presentation, biochemical and radiological features, and operative findings from the case records of the last 16 (1992–2008) years including 101 patients at a tertiary care centre in the Eastern Black Sea region of Turkey who had documented PHPT.

Results: The female:male ratio was 4.9:1 with ages ranging from 19 to 84 years (mean±S.D., 56.0±13.54 years). Renal symptoms were the major symptoms in 61 patients (60.3%) followed by gastrointestinal symptoms in 59 patients (58.4%) and weakness/fatigue in 54 patients (53.4%). Common clinical manifestations included nocturia (40.5%), bone pain (36.6%), constipation (32.6%), polyuria (31.6%). Renal stone was present in 31 patients (30.6%). Hypertension was observed in 43 patients (42.5%). Only two patients were asymptomatic. In seven patients, serum calcium level were in normal range while serum calcium levels were higher than normal in other patients. Mean intact PTH level (±S.D.) was 461.27±553.14 pg/ml. In direct bone X-rays examination had 49 patients (48.5%) had salt-pepper appearance of cranium, 37 patients (36.6%) had subperiosteal resorption, four patients (3.9%) had bone cysts and Brown tumor and six patients (5.9%) had pathologic fractures. Seventy patients (69.3%) undergone were operation.

Conclusion: Almost all of the patients presented with late symtoms and complications of PHPT. Serum calcium and phosphorus were the best screening tests for the diagnosis of PHPT in this series. The diagnosis should be further confirmed determining the intact PTH level.