Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by inappropriate secretion of parathyroid hormone leading to hypercalcemia. The aim of our study is to evaluate the clinical and etiological aspects of PHPT in our series.

Methods: This is a retrospective descriptive study including 32 patients followed for PHPT at the endocrinology department of the military hospital of Tunisia between January 2018 and December 2022. Clinical and paraclinical data were collected from medical records.

Results: The mean age was 59,4 ± 13 years with a predominance of women: sex ratio (H/F) =0,68. PHPT was discovered fortuitously by a routinely biological check-up in 40,6% of cases and by an incidentaloma in 15,6% of cases. The diagnosis of PHPT was revealed by complications in 28,1% of cases (bone pain in 25% of cases, renal lithiasis in 3,1% of cases) and by the presence of general signs related to hypercalcaemia in 15,6% of cases. The mean calcemia was 2.98 ± 0,36 mmol/l with severe hypercalcemia (up to 3.5 mmol/l) in 9.4 % cases. Patients had hypophosphoremia in 19,4 % of cases and hypercalciuria in 60,8% of cases. The mean parathormone level was 292,9 ± 322,2pg/ml. The mean 25-OH-vitamin D level was 16.23 ± 9,05ug/dl. Normocalcemic HPTP was present in one case. Renal ultrasound showed lithiasis in 53% of cases. None of the patients had nephrocalcinosis. Thirty-four percent of cases had renal insufficiency. Bone densitometry revealed osteoporosis in 9.4% of cases, osteopenia in 50% of cases and was normal in 40.6% of cases. A cervical ultrasonography associated with a Technicium-SestaMIBI parathyroid scintigraphy was performed in all our patients. The etiologies identified were a parathyroid adenoma in 75% of cases and parathyroid hyperplasia in 25% of cases among which one case of multiple endocrine neoplasia type 1.

Conclusion: Most often, the presentation of PHPT is asymptomatic with the advent of the routine measurement of serum calcium. A rigorous etiological assessment and screening for complications is needed to provide optimal management.