Primary hyperparathyroidism in Saudi Arabia revisited: a multi-centre observational study

Al‐Saleh, Yousef; AlSohaim, Abdullah; Alamoudi, Reem; Alqarni, Ali; Alenezi, Raed; Mahdi, Layla K.; Alzanbaqi, Hend; Nawar, Samah M.; AlHarbi, Hibah; ALMulla, Abdulrhman; Qahtani, Maryam Al; Salih, Salih Bin; Anazi, Faisal Al; Saleh, Najla; Saleh, Seham; AlAklabi, Ali; Sabico, Shaun; Al‐Daghri, Nasser

doi:10.1186/s12902-022-01059-7

Cited by 4 publications

(3 citation statements)

References 23 publications

(24 reference statements)

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“…As reported in other studies (16, [20][21][22], nephrolithiasis was the most common presenting feature; the prevalence of osteoporosis was lower compared with studies reporting similar rates of symptomatic PHPT (5,6,16,21,22) and may be explained by less frequent screening for hypercalcaemia at primary levels of care.…”

Section: Discussionmentioning

confidence: 46%

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Govind,

Paruk,

Motala

2024

Preprint

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Background: There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH.Methods: A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded.Results: Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59;45.38) pmol/l, alkaline phosphatase 117.5 (89;145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26;62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008)Conclusions: The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.

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Section: Discussionmentioning

confidence: 46%

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Govind,

Paruk,

Motala

2024

Preprint

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“…As reported in other studies [ 16 , 20 – 22 ], nephrolithiasis was the most common presenting feature; the prevalence of osteoporosis was lower compared with studies reporting similar rates of symptomatic PHPT [ 5 , 6 , 16 , 21 , 22 ] and may be explained by less frequent screening for hypercalcaemia at primary levels of care.…”

Section: Discussionmentioning

confidence: 59%

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

Govind,

Paruk,

Motala

2024

BMC Endocr Disord

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Background There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH. Methods A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded. Results Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008). Conclusions The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.

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“…In Saudi Arabia, a retrospective multi-center study showed a mean age of 59.8 ± 15.5 years, with more women than men (3/1) [13].…”

Section: Age and Gendermentioning

confidence: 99%

<sup>99m</sup>Tc-Mibi Parathyroid Scintigraphy in the Exploration of Hyperparathyroidism in Senegal: A Study of 66 Cases in the Idrissa Pouye General Hospital, Dakar

Bathily,

Thiaw,

Diop

et al. 2024

EJB

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Hyperparathyroidism is a common endocrinopathy, and parathyroid scintigraphy is part of the preoperative work-up. A prerequisite for adenoma surgery is precise localization of the pathological gland(s) concerned. Our aim was to review the parathyroid scans performed for hyperparathyroidism in Senegal. We carried out a retrospective study over a period of 2.5 years, including patients with hyperparathyroidism who underwent parathyroid scintigraphy with 99m Tc-MIBI, in the nuclear medicine department of the Idrissa Pouye General Hospital in Dakar. A total of 66 patients were included. The mean age was 52 years, with a sex ratio (M/F) of 0.34. The majority of patients were from the capital, Dakar (93%). Primary hyperparathyroidism was the predominant indication (70%). Most patients were symptomatic. Mean parathyroid hormone (PTH) and Calcemia were 464 pg/ml and 98 mg/l respectively. Ultrasound revealed a thyroid nodule in 35% of cases. The scintigraphy was in favour of parathyroid adenoma (30%) with a predominant right upper location (right P4) (35%) and poor concordance between cervical ultrasound and parathyroid scintigraphy was observed with a kappa coefficient k=0.04. Parathyroid scintigraphy with 99m Tc-MIBI allows precise localization of hyper functioning glands, enabling unilateral or minimally invasive cervical surgery to be adopted and reducing the therapeutic failure rate.

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Primary hyperparathyroidism in Saudi Arabia revisited: a multi-centre observational study

Cited by 4 publications

References 23 publications

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

<sup>99m</sup>Tc-Mibi Parathyroid Scintigraphy in the Exploration of Hyperparathyroidism in Senegal: A Study of 66 Cases in the Idrissa Pouye General Hospital, Dakar

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Primary hyperparathyroidism in Saudi Arabia revisited: a multi-centre observational study

Cited by 4 publications

References 23 publications

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Characteristics, Management and Outcomes of Primary Hyperparathyroidism from 2009 to 2021: a single centre report from South Africa.

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

&lt;sup&gt;99m&lt;/sup&gt;Tc-Mibi Parathyroid Scintigraphy in the Exploration of Hyperparathyroidism in Senegal: A Study of 66 Cases in the Idrissa Pouye General Hospital, Dakar

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<sup>99m</sup>Tc-Mibi Parathyroid Scintigraphy in the Exploration of Hyperparathyroidism in Senegal: A Study of 66 Cases in the Idrissa Pouye General Hospital, Dakar