Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience
Keywords:Clinical profile, Hypercalcaemia, Northeast India, Osteitis fibrosa cystica, Parathyroid adenoma, Primary hyperparathyroidism
Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.
Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p<0.05.
Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.
Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution.
Bilezikian JP. Approach to Parathyroid Disorders. Rosen CJ, Bouillon R, Compston JE, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. Wiley Blackwell, American Society for Bone and Mineral Research; 2013:537-542.
Silverberg SJ. Primary Hyperparathyroidism. Rosen CJ, Bouillon R, Compston JE, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. Wiley Blackwell, American Society for Bone and Mineral Research; 2013:543-552.
Bilezikian JP. Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2018;103(11):3993-4004.
Albright F. A page out of the history of hyperparathyroidism. J Clin Endocrinol Metab. 1948;8(8):637-57.
Bhadada SK, Arya AK, Mukhopadhayay S, Khadgawat R, Sukumar S, Lodha A, et al. Primary hyperparathyroidism: insight from the Indian PHPT registry. J Bone Miner Metab. 2018;36(2):238-45.
Parmar G, Chadha M. The Changing Face of Primary Hyperparathyroidism. Indian J Endocr Metab. 2018;22:299-300.
Silverberg SJ, Bilezikian JP. “Incipient” primary hyperparathyroidism: a “forme fruste” of an old disease. J Clin Endocrinol Metab. 2003;88(11):5348-52.
Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ. Normocalcaemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab. 2007;92(8):3001-5.
Pawlowska M, Cusano NE. An overview of normocalcaemic primary hyperparathyroidism. Curr Opin Endocrinol Diabetes Obes. 2015;22(6):413-21.
Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Monteiro R, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population based analysis from the electronic medical record. Surgery. 2013;154(6):1232-8.
Kontogeorgos G, Trimpou P, Laine CM, Olero¨ d G, Lindahl A, Landin-Wilhelmsen K. Normocalcaemic, vitamin D-sufficient hyperparathyroidism-high prevalence and low morbidity in the general population: a long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden. Clin Endocrinol. 2015;83(2):277-84.
Vignali E, Cetani F, Chiavistelli S, Meola A, Saponaro F, Centoni R, et al. Normocalcaemic primary hyperparathyroidism: a survey in a small village of Southern Italy. Endocr Connect. 2015;4(3):172-8.
Cusano NE, Maalouf NM, Wang PY, Zhang C, Cremers SC, Haney EM, et al. Normocalcaemic hyperparathyroidism and hypoparathyroidism in two community based non referral populations. J Clin Endocrinol Metab. 2013;98(7):2734-41.
Bhansali A, Masoodi SR, Reddy KS, et al. Primary hyperparathyroidism in north India: a description of 52 cases. Ann Saudi Med. 2005;25:29-35.
Muthukrishnan J, Jha S, Modi KD, Jha R, Kumar J, Verma A, et al. Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre. J Assoc Physician India. 2008;56:503-6.
Gopal RA, Acharya SV, Bandgar T, Menon PS, Dalvi AN, Shah NS. Clinical Profile of Primary Hyperparathyroidism from Western India: A single centre experience. J Postgrad Med. 2010;56:79-84.
Pradeep PV, Jayashree B, Mishra A, Mishra SK. Systematic Review of Primary Hyperparathyroidism in India: The Past, Present, and the Future Trends. Int J Endocrinol. 2011;1-7.
Maskey R, Panchani R, Varma T, Goyal A. Primary hyperparathyroidism in India: A cocktail of contemporary and classical presentations: Lesson from 47 cases. Indian J Endocr Metab. 2013;17:S209-11.
Misgar RA, Dar PM, Masoodi SR, Ahmad M, Wani KA, Wani AI, et al. Clinical and laboratory profile of primary hyperparathyroidism in Kashmir Valley: A single-centre experience. Indian J Endocr Metab. 2016;20:696-701.
Mallikarjuna VJ, Mathew V, Ayyar V, Bantwal G, Ganesh V, George B, et al. Five-year retrospective study on primary hyperparathyroidism in South India: Emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography-computed tomography scan. Indian J Endocr Metab. 2018;22:355-61.
Jha S, Jayaraman M, Jha A, Jha R, Modi KD, Kelwadee JV. Primary hyperparathyroidism: A changing scenario in India. Indian J Endocr Metab. 2016;20:80-3.
Parmar G, Lala M, Chadha M, Shah NF, Chauhan PH. Study of primary hyperparathyroidism. Indian J Endocr Metab. 2012;16:S418-20.
Shah VN, Bhadada S, Bhansali A, Behera A, Mittal BR. Changes in clinical and biochemical presentations of primary hyperparathyroidism in India over a period of 20 years. Indian J Med Res. 2014;139:694‑9.
Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J, et al. Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg. 2001;88:708‑14.
Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. Williams Textbook of Endocrinology. 13th ed. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, Elsevier; 2016.
Harinarayan CV, Gupta N, Kochupillai N. Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol. 1995;43:351-8.
National Family Health Survey-4. State Fact Sheet-Assam. Ministry of health and family welfare, Government of India, 2015-2016. Available at: http://rchiips.org/nfhs/pdf/NFHS4/AS_FactSheet.pdf. Accessed on 6 February 2019.
Boxer M, Ellman L, Geller R, Wang C. Anaemia in primary hyperparathyroidism. Arch Intern Med. 1977;137(5):588-90.
Bhadada SK, Sridhar S, Ahulwalia J, Bhansali A, Malhotra P, Behera A. Anaemia and thrombocytopenia improves after curative parathyroidectomy in a patient of primary hyperparathyroidism. J Clin Endocrinol Metab. 2012;95(5):1420-2.
Marzouki HZ, Chavannes M, Tamilia M, Hier MP et al. Location of parathyroid adenomas: 7-year experience. J Otolaryngol Head Neck Surg. 2010;39(5):551-4.