Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is a common endocrinopathy caused by inappropriate PTH secretion by the parathyroid glands, which leads to alterations in phosphocalcic metabolism. The aim of our study is to determine the prevalence of complications of PHPT.

Materials and Methods: Retrospective descriptive study of 83 patients with primary hyperparathyroidism collected over a period of 07 years (between 2015 and 2022) in the endocrinology department at the Ibn Sina University Hospital of Rabat and in the endocrinology department of the Mohamed V training military hospital, Clinical and paraclinical parameters were collected from patient records.

Results: Our series encompasses 83 patients, with an average age of 53.27 years (range: 11-85), notably demonstrating a pronounced female predominance in 90.4% of cases. Functional manifestations were diverse, with 65.6% presenting with bone-related symptoms, 10.8% exhibiting urinary signs, 15.7% displaying digestive symptoms, 10.8% manifesting cardiovascular issues, and 6.5% experiencing neuropsychological and neuromuscular symptoms, along with a 6% incidence of QT interval shortening. Complications observed were widespread, with 48.2% exhibiting bone-related complications, encompassing fractures in 14.5% of cases and brown tumors in 9.6%. Bone densitometry, performed in 85.5% of cases, revealed osteoporosis in 33.7% and osteopenia in 20.5%. Additionally, digestive complications accounted for 4.8%, with two cases of pancreatitis, while renal complications were observed in 10% of cases. This comprehensive analysis provides a detailed overview of the clinical spectrum and complications associated with primary hyperparathyroidism in our patient cohort.

>Discussion & Conclusion: Primary hyperparathyroidism emerges as a disorder characterized by the inappropriate secretion of parathyroid hormone, consequently leading to hypercalcemia. Typically discovered incidentally due to elevated serum calcium levels or, less frequently, in the context of complications such as osteoporosis or, more rarely, digestive issues like pancreatitis. The clinical ramifications of PHPT are primarily associated with chronic hypercalcemia, hypercalciuria, or hyperparathormonemia. Within the skeletal system, excess parathyroid hormone fosters heightened bone resorption, suppressing osteoblastic activity while augmenting the osteoclast pool. This imbalance contributes to significant bone remodeling, reduced bone mineral density, and subsequently, the development of osteoporosis and bone fractures. In the renal system, there is an increase in tubular reabsorption of calcium and urinary excretion of phosphates, resulting in hypercalciuria. This elevated urinary calcium excretion can predispose individuals to episodes of renal lithiasis (20%) or, less commonly, nephrocalcinosis. The intricate interplay between parathyroid hormone, calcium metabolism, and renal function underscores the multifaceted clinical consequences of primary hyperparathyroidism.