Primary hyperparathyroidism: Achanging scenario in India

Jha, Sangeeta; Muthukrishnan, J; Jha, Aman; Jha, Ratan; Modi, Kirtikumar D; Kelwadee, Jayant V

doi:10.4103/2230-8210.172237

Cited by 27 publications

(16 citation statements)

References 4 publications

(5 reference statements)

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“…[ 14 15 ] Our study is not in agreement with the results of other Indian studies where majority of patients were <40 years of age. [ 16 17 18 ] In one study from Kashmir, the mean age of patients at presentation was 44.72 ± 12.46 years which matches with our data probably because 62% of patients in that study were enrolled after 2012. [ 19 ] The reason why PHPT presents at a younger age in our country is possibly because of the associated Vitamin D deficiency.…”

Section: Discussionsupporting

confidence: 83%

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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

Mallikarjuna

Mathew

Ayyar

et al. 2018

Indian J Endocr Metab

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Background:Primary hyperparathyroidism (PHPT) is a common endocrine disease with a variable clinical presentation. PHPT is usually symptomatic at presentation in majority of the patients, especially in developing countries. As the accessibility to investigations, advanced imaging methods and surgical procedures are improving, the clinical profile of the patients with PHPT has undergone a palpable change compared to the earlier description. Hence we decided to look for a change in clinical, imaging and surgical outcomes of PHPT patients from South India.Methods:We collected the data on clinical presentation, biochemistry, radiological features and operative findings of patients with PHPT treated in our hospital from 2011-2015. Cases of PHPT were identified from the laboratory values using the biochemical criteria, after the exclusion of secondary and tertiary hyperparathyroidism cases.Results:Our study identified 54 patients (19 males and 35 females) with age ranging from 16 to 71 years. A Significant proportion(38.9%) of the patients were asymptomatic. Musculoskeletal symptoms (40.7%), renal manifestations (27.7%) and gastrointestinal system involvement (27.7%) constituted the other common modes of presentation. CNS involvement was seen in 3 patients. A palpable nodule in the neck was detected in 4 patients. Interestingly 4 patients were managed for parathyroid crisis at presentation. Biochemical features included hypercalcaemia (100%) and hypophosphatemia (59%) with a mean intact PTH level of 602.0±721.3 pg/ml. Sensitivity of Ultrasonography and Tc99M Sestamibi was 72% and 70.6% respectively for detecting a parathyroid adenoma. Sensitivity of C11 methionine PET-CT was 71.4% in those patients who were negative for other imaging modalities. Forty three patients (79.6%) underwent minimally invasive parathyroidectomy.Conclusion:In South India we have a notable change in the clinical presentation of PHPT from a symptomatic to an asymptomatic state. C11 Methionine PET - CT is an emerging modality for preoperative localisation especially when other imaging modalities are negative and when a minimally invasive parathyroidectomy is desired.

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Section: Discussionsupporting

confidence: 83%

“…Around 59.3% of patients in our study had elevated alkaline phosphatase level which is in agreement with the studies done in North India. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

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

Mallikarjuna

Mathew

Ayyar

et al. 2018

Indian J Endocr Metab

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“…Another interesting finding is that there are more male and premenopausal female PHPT patients from Changsha than from Western countries. This finding is consistent with previous studies in Chinese and Indian PHPT patients [ 3 , 6 , 19 ]. Our data showed similarities between male and premenopausal female PHPT patients which is consistent with the recent study by Castellano et al [ 20 ].…”

Section: Discussionsupporting

confidence: 94%

Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha

Meng

Liu

Al-Dayyeni

et al. 2018

International Journal of Endocrinology

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Purpose To compare the initial clinical features, laboratory values, and bone mineral density among patients with primary hyperparathyroidism (PHPT) in Changsha (China) and New Brunswick (USA). Methods In this retrospective study, we reviewed 169 PHPT patients who presented at Robert Wood Johnson University Hospital and 133 PHPT patients who presented at the Second Xiangya Hospital of Central South University in the same time period. The following characteristics were compared between the groups: age, gender, BMI, serum calcium, alkaline phosphatase (AKP), albumin, intact PTH (iPTH), 25-hydroxyvitamin D (25 (OH) D), fasting blood glucose levels, and bone mineral density (BMD). All these parameters were also compared according to gender and menopausal status. iPTH associations were also assessed along with several other parameters. Results PHPT patients from Changsha had higher serum calcium, iPTH, and AKP levels but lower 25 (OH) D levels than the patients from New Brunswick (p < 0.05). Patients in Changsha had lower T-scores and Z-scores in both the lumbar spine and hip regions than those in New Brunswick (p < 0.05). Patients in New Brunswick had lower percentages of parathyroid adenoma and kidney stones. Serum iPTH level was positively correlated with serum calcium and serum AKP levels in both Changsha and New Brunswick (p < 0.05). Conclusions There are distinct biochemical and clinical differences between patients with PHPT in China and the United States. Our study revealed that Asian PHPT patients from Changsha presented more severe PHPT profiles, lower bone mineral density, and higher incidence of renal stones.

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“…Data from different studies published from India indicate that the incidence of asymptomatic PHPT is around 5%–38%. [ 3 4 5 6 7 8 9 10 ]…”

mentioning

confidence: 99%

“…Musculoskeletal system remains the most common system affected due to PHPT followed by renal and gastrointestinal system. [ 3 4 5 6 7 8 9 10 ] Only one study from Kashmir reported renal involvement to be the most common finding in symptomatic PHPT. [ 9 ] Neuropsychiatric manifestations of PHPT have been reported to be less frequent.…”

mentioning

confidence: 99%