Bone Abstracts (2014) 3 PP389 | DOI: 10.1530/boneabs.3.PP389

Changing clinical profile of primary hyperparathyroidism in Indian patients

Ambrish Mithal1, Parjeet Kaur1, Beena Bansal1, Sunil Mishra1, V P Singh2 & Deepak Sarin1

1Medanta, The Medicity Hospital, Gurgaon, Haryana, India; 2Indraprastha Apollo Hospital, New Delhi, Delhi, India.

Background: Primary hyperparathyroidism (PHPT) has evolved into an asymptomatic disease in the west. In contrast classic symptoms of PHPT have been reported to be common in the East with as many as 80–100% of PHPT patients presenting with bone manifestations in India.

Objective: To describe clinical and biochemical profile of patients diagnosed with PHPT between years 2009 and 2012.

Methodology: This was a retrospective study conducted at two tertiary care centres in India. All patients who underwent evaluation and surgery for PHPT from January 2009 to December 2012 were included in the study. Ethical clearance was obtained from Institutional Review Board.

Results: A total of 50 patients with PHPT were admitted between years 2009 and 2012. Among them, 31 (62%) were symptomatic and 19 (38%) were asymptomatic. Mean age (S.D.) was 48.3 (15.8). Female: male ratio was 1.9:1. Skeletal manifestations in total cohort were bone pains in 30% and fracture in 16%. Renal calculi were present in 20% of patients. The asymptomatic group had significantly lower median adenoma weight (0.57 vs 3.4, P<0.05), higher mean age (57.3 vs 42.8 years, P<0.05) and lower median intact parathormone (iPTH) level (254.5 vs 295 pg/ml, P<0.05) as compared to symptomatic group. Parathyroid adenoma weight was positively correlated with baseline serum calcium, iPTH and alkaline phosphatase levels. No correlation was found between serum 25-hydroxyvitamin D3 level and any of the biochemical parameters or adenoma weight.

Conclusions: In contrast to earlier reports, asymptomatic form of PHPT was found in significant percentage of Indian patients in this study. Asymptomatic PHPT patients were older in age and had lower parathyroid adenoma weight as compared to symptomatic PHPT patients. Positive correlation was found between parathyroid adenoma weight and serum calcium, iPTH and alkaline phosphatase levels.

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