Endocrine Abstracts

Introduction: Surgery is the only curative treatment for primary hyperparathyroidism (PHPT). However, some patients may present a persistence or a recurrence after surgical treatment. The aim of our study was to evaluate the therapeutic and evolutive aspects of PHPT after the first surgery.

Methods: A retrospective study was conducted at the endocrinology department of military hospital of Tunis including 32 patients diagnosed with PHPT over a period of four years (between 2018 and 2022). Clinical and paraclinical data were collected from medical records.

Results: Our population was composed of 13 men and 19 women with a mean age of 59 ± 13 years old. The mean parathormone (PTH) level was 292 ± 322 pg/ml. The mean calcemia was 3 ± 0,4 mmol/l. All our patients received rehydration. Three percent were treated with bisphosphonates. Nineteen patients underwent surgery. Adenectomy was performed for 17 patients and removal of 3/4 of the parathyroids for two patients. The anatomopathological examination revealed parathyroid adenoma in 75% of cases and parathyroid hyperplasia in 25% of patients. Regarding patients who have underwent surgery, the evolution was marked by a remission rate in 42% of cases. Persistence of PHPT was observed in 10 patients (53%). Among these patients, three had multiple adenomas, one had an ectopic adenoma of the superior mediastinum and six had hyperplasia of other parathyroids. Recurrence of PHPT was observed in one patient who had hyperplasia of parathyroids related to multiple endocrine neoplasia type 1.

Conclusion: Persistence and recurrence rates highlight the importance of preoperative topographic investigation and intraoperative PTH measurement to improve the prognosis of PHPT.