Endocrine Abstracts

Background: Primary hyperparathyroidism (PHPT) is characterized by abnormal regulation of PTH secretion by calcium. The most common clinical presentation of PHPT is asymptomatic (80% cases), followed less likely by the classical symptoms of bones, stones, abdominal moans, and psychic groans. The diagnosis of PHPT is usually first suspected because of the finding of an elevated serum calcium concentration along with a rise in Parathyroid hormone (PTH) level. Serum phosphorus levels are usually normal to high in patients with PHPT. These investigations are then followed by the localization studies such as Ultrasound Neck, Sestamibi scan or CT/MRI scan. Parathyroid adenoma resection is the only definitive treatment to cure the disease.

Objectives: This study was designed primarily for the evaluation of diagnostic characteristics and management outcomes of PHPT over a span of 10 years at a tertiary care hospital in Pakistan.

Methods: It was a Descriptive cohort study. Total 55 patients with biochemical and radiological diagnosis of PHPT were included in study between January, 2007 to December, 2016. Patients’ medical record files were reviewed & data recorded.

Results: Of the 55 subjects, with mean age of 39.68±14.35 years, 44 (80%) were females while 11 (20%) were males. The patients presented at a mean duration of 1.20±3.12 years after onset of symptoms. The most frequent complaint was joint & bone pains noted by 49 (89.1%) pts. SestaMIBI scan proved the culprit lesion to be on the right side of neck in 24 (43.6%) pts, left side in 22 (40%) pts and bilateral in 7 (12.8%) pts. Overall, 40 (72.7%) patients underwent surgical resection of parathyroid adenoma, out of which 33 (82.5%) achieved remission while the rest had to undergo repeat surgery to achieve remission. Fifteen (27.3%) patients refused to opt surgical option, thus not achieving remission. Alendronate was the most commonly adopted medical treatment.

Conclusion: To the best of our knowledge, this important endocrinal entity of PHPT had never been studied in Pakistan in terms of estimating the prevalence of its clinical profile, understanding the diagnostic characteristics in our set-up and observing the management outcome. PHPT most commonly presents with skeletal manifestations (80.1%) in our area. Surgical adenoma resection is followed by the documentation of remission in 82.5% pts. With the continuously improving surgical skills, we expect that the figures attaining remission after primary surgical resection will rise in the decades to come.