Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India

Yadav, Sanjay Kumar; Mishra, Saroj Kanta; Mishra, Anjali; Mayilvagnan, Sabaretnam; Chand, Gyan; Agarwal, Gaurav; Agarwal, Amit; Verma, Ashok Kumar

doi:10.1007/s00268-018-4575-0

Cited by 20 publications

(23 citation statements)

References 45 publications

(46 reference statements)

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“…While the developed world focused on laying guidelines for filtering out cases of asymptomatic PHPT for surgical intervention and promoting minimal access surgery with the aid of newer diagnostic and localization tools, the developing world was observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and a reduction in incidence of associated Vitamin D deficiency. Some authors from developing countries have focused on the changing clinical spectrum of PHPT (6)(7)(8)(9)(10) and suggested that the trajectory of the change is similar to what was observed in developed countries a few decades earlier. We observed these dramatic changes in disease epidemiology and sought to review and address the question that whether the epidemiology of this disease continues to differ from the developed countries?…”

Section: Introductionmentioning

confidence: 88%

“…Yadav and cols. grouped the PHPT patients into three subgroups based on the time span; 1990-1999, 2000-2009, 2010-2016, and clinical and biochemical parameters were compared (10). The clinical presentation in this study has evolved progressively with increase in older age group (35 vs 39 vs 43.85, p < 0.001), less patients with musculoskeletal symptoms (85.3 vs 76.8 vs 61%, p = 0.002) and less patients with severe bone disease (29.4 vs 10.7 vs 10.7%, p = 0.088).…”

Section: Changing Epidemiologymentioning

confidence: 99%

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Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease

Yadav¹,

Johri²,

Bichoo³

et al. 2020

Archives of Endocrinology and Metabolism

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While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1 st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.

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Section: Introductionmentioning

confidence: 88%

Section: Changing Epidemiologymentioning

confidence: 99%

Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease

Yadav¹,

Johri²,

Bichoo³

et al. 2020

Archives of Endocrinology and Metabolism

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“…The main contributing factor to the shift in the clinical presentation of pHPT is probably an iceberg phenomenon with a higher detection rate of patients affected. Studies from China, India and Brazil, amongst other countries, still show a dominant percentage of pHPT patients with classic symptoms and more severe biochemical abnormalities but the differences are being levelled out . Access to biochemical screening of calcium levels seems to be the crucial factor.…”

Section: Evolving Concepts Of Primary Hyperthyroidismmentioning

confidence: 99%

Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties

Nilsson

2018

J Intern Med

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Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately ‘normal’ levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3–5%, is observed amongst women, and the prevalence increases with age. The female‐to‐male ratio is 3–4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost‐effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.

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“…[27282930] Most of these studies are from developed countries where the clinical profile of PHPT patients is totally different[31] as compared to developing world. Although clinical profile of PHPT is changing in the developing world[19] but it continues to be a symptomatic disorder with skeletal, renal and metabolic complications at a much younger age. [31821222332333435] Most of the studies demonstrating non-superiority of CPTx over FPTx have been done in a patient population where the majority of the cases are asymptomatic screen detected PHPT.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective study of all PHPT patients treated in the Department of Endocrine surgery, SGPGIMS, Lucknow between January 1990 to December 2017. The evaluation and diagnostic protocol at our institute has been published in our previous publications[31819] and [Doc S1]. The patient cohort was divided into 2 groups, based on operative approach (CPTx vs FPTx) or use of IOPTH (Intraoperative parathyroid harmone monitoring) vs. no use of IOPTH.…”

Section: Methodsmentioning

confidence: 99%

Surgical management of primary hyperparathyroidism in the era of focused parathyroidectomy: A study in tertiary referral centre of North India

Yadav

Mishra

et al. 2019

Indian J Endocr Metab

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Background:Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients.Material and Methods:This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively.Results:Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively (P = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH (n = 213) and FPTx without IOPTH (n = 28). The outcome did not differ between two groups statistically.Conclusion:FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients.

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Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India

Abstract: Our study reveals a change in trend in PHPT which is similar to evolution of this disease in western population and positively corroborated with observations from China, Hong Kong and Turkey.

Cited by 20 publications

References 45 publications

Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease

Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease

Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties

Surgical management of primary hyperparathyroidism in the era of focused parathyroidectomy: A study in tertiary referral centre of North India

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