Indian journal of endocrinology and metabolism · 2025
Primary Hyperparathyroidism: Clinical, Biochemical, and Radio-Pathological Profiles of 804 Patients - A Retrospective Study from South India.
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Sadacharan Dhalapathy, Mathews Mano Z, Sathya Anjali, Gopal Shanmugasundar, Chandrasekaran Sruti, Murthy Sivasubramaniam, Reddy Vijaya B, Gopal Jayashree, Jeyapaul Muthukumaran, Sivasubramanian Sakthivel, Gopalakrishnan Vignesh, Ramji Bharath, Goli Dinesh, Sundararaman Gokulakrishnan, Mahadevan Shriraam
Аннотация
INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder with variable clinical presentation. We intend to describe the clinical, biochemical, and radio-pathological profiles of PHPT patients managed over 13 years from South India.
METHODS: We analysed all patients who underwent evaluation and surgery for PHPT from July 2011 to April 2024.
RESULTS: A total of 862 PHPT patients underwent parathyroidectomy, with female preponderance (61.2%). Analysis was done on 804 patients (>20 years of age) excluding adolescent and paediatric age groups. The mean age was 43.8 years. The presentation in decreasing order of frequency was weakness and fatigue (84.2%); bone pain (35%); renal disease (20.8%) in the form of nephrolithiasis, nephrocalcinosis, or renal dysfunction; and neuropsychiatric manifestations (23.8%). Pathological fractures were observed in 4.5%, hypercalcaemic crisis in 2.6% of patients, and 1% had MEN I (Multiple Endocrine Neoplasia) syndrome. The mean albumin adjusted serum calcium level was 12.3 ± 1.01 mg/dl, and the median serum PTH level was 338 (80-3864) pg/ml. The sensitivity of the ultrasound neck and 99mTc Sestamibi scan was 97.5% and 98.3%, respectively, with a concordance of 93.4%. 25% underwent bilateral neck exploration and parathyroidectomy. Lesions were ectopic in 20 (2.4%) patients. The mean parathyroid gland weight was 1.45 ± 0.75 g. Histopathology revealed parathyroid adenoma (93.5%), parathyroid hyperplasia (1.6%), and parathyroid carcinoma (2.2%). The cure rate was 99.3%, while three patients had persistent disease. Hungry bone syndrome was observed in 12.1%.
CONCLUSION: There is a changing trend in the clinical and biochemical profiles of PHPT patients in India to a milder form of the disease. The incidence of parathyroid carcinoma was slightly higher compared to a few other centres in India.
METHODS: We analysed all patients who underwent evaluation and surgery for PHPT from July 2011 to April 2024.
RESULTS: A total of 862 PHPT patients underwent parathyroidectomy, with female preponderance (61.2%). Analysis was done on 804 patients (>20 years of age) excluding adolescent and paediatric age groups. The mean age was 43.8 years. The presentation in decreasing order of frequency was weakness and fatigue (84.2%); bone pain (35%); renal disease (20.8%) in the form of nephrolithiasis, nephrocalcinosis, or renal dysfunction; and neuropsychiatric manifestations (23.8%). Pathological fractures were observed in 4.5%, hypercalcaemic crisis in 2.6% of patients, and 1% had MEN I (Multiple Endocrine Neoplasia) syndrome. The mean albumin adjusted serum calcium level was 12.3 ± 1.01 mg/dl, and the median serum PTH level was 338 (80-3864) pg/ml. The sensitivity of the ultrasound neck and 99mTc Sestamibi scan was 97.5% and 98.3%, respectively, with a concordance of 93.4%. 25% underwent bilateral neck exploration and parathyroidectomy. Lesions were ectopic in 20 (2.4%) patients. The mean parathyroid gland weight was 1.45 ± 0.75 g. Histopathology revealed parathyroid adenoma (93.5%), parathyroid hyperplasia (1.6%), and parathyroid carcinoma (2.2%). The cure rate was 99.3%, while three patients had persistent disease. Hungry bone syndrome was observed in 12.1%.
CONCLUSION: There is a changing trend in the clinical and biochemical profiles of PHPT patients in India to a milder form of the disease. The incidence of parathyroid carcinoma was slightly higher compared to a few other centres in India.