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

Abstract

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.

Evaluation of surgical treatment outcomes for primary hyperthyroidism: A single center experience

“…In our study, the most common reason for admission in symptomatic patients was musculoskeletal complaints, while the most common surgical indications in asymptomatic patients were decreased bone mineral density and urinary system stones. Although the surgical indications, symptoms, and laboratory findings of our patients were consistent with the literature, the number of symptomatic patients (%72.15) was higher than expected, contrary to the western literature (1,11,12). However, we are of the opinion that this rate cannot be generalized for our country.…”

Diagnosis and treatment of primary hyperparathyroidism (20 years of own experience and literature review)

“…Ураження нирок також належить до основних маркерів захворювання й зустрічається у 60 % хворих. Підвищення фільтрації Са внаслідок пГПТ і гіперкальціємії призводить до розвитку нефролітіазу, зниження швидкості клубочковоі фільтрації [27,28].…”

“…Системна гіперкальціємія призводить до різнобічного впливу на периферичну нервову систему. Виявляються підвищена втомлюваність, порушення сну, зниження пам'яті, психічні порушення різного ступеня [27,28].…”

Biochemistry in Symptomatic and Asymptomatic Primary Hyperparathyroidism: A Cross-Sectional Study

“…Its prevalence is around 0.2-0.5% and increases after 65 years and in postmenopausal women 6,7 . Latin American PHPT prevalence reports vary from 4 to 8 cases per 1000 inhabitants, with no defined prevalence in Mexico [8][9][10] . PHPT diagnosis is made by high serum calcium levels and elevated, or inappropriately normal, PTH and commonly diagnosed in the past by skeletal and/or renal complications, defined as classic symptoms [11][12][13] .…”