Primary hyperparathyroidism: insights from the Indian PHPT registry

Abstract

The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry ( http://www.indianphptregistry.com ) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41 ± 14 years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9 ± 1.6 mg/dL, 752.4 ± 735.2 pg/mL and 2.8 ± 0.9 mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6 ± 6.5 g (0.1-54 g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT.

Minimally invasive parathyroid carcinoma—A missing entity between parathyroid adenoma and carcinoma: Scintigraphic and histological features

“…In the current study, serum iPTH and calcium levels in patients of MIPC were in range lying between patients of PA and PC. Previous studies from Indian subcontinent also showed that the PTH level of PC patients was significantly higher than of PA . The mean tumour weight in patients with MIPC was higher compared with patients with PA seen in Indian and global population (5.6 and 2.7 g) …”

“…Parathyroid adenoma is the major cause for primary hyperparathyroidism (PHPT) adding up to 85% of all PHPT followed by parathyroid hyperplasia (10%‐15%) and rarely due to parathyroid carcinoma (<1%) . Sporadic parathyroid tumours causing PHPT are categorized into typical parathyroid adenoma (PA), parathyroid hyperplasia, parathyroid carcinoma (PC) and rarely atypical parathyroid adenoma (APA) .…”

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

“…Other studies from different parts of India show a higher female preponderance with female to male ratio ranging from 2:1 to 6:1. 5,6,[14][15][16][17][18][19][20][21][22][23][24] The incidence in hyperparathyroidism is typically described in the sixth decade. 3 In our study, 55.5% of the patients were less than 40 years and 18.5% were younger than 20 years (mean 39±16.7).…”

“…3,4 Data from Indian PHPT registry published in 2018 showed that 95% of PHPT were symptomatic disease. 5 The use of routine biochemical screening since 1970, has led to the emergence of asymptomatic PHPT as the predominant form in the western world. 3 There is an increase in incidence of asymptomatic PHPT in India, reported to be around 5-38%.…”

Primary Hyperparathyroidism Presenting as Posterior Reversible Encephalopathy Syndrome: A Report of Two Cases

“…This probably reflects the relatively mild-moderate levels of serum calcium seen in PHPT patients. In a registry of 464 patients with histologically proven PHPT, the mean calcium level was 11.9 mg/dl (28). In addition to absolute calcium levels, the rate of rise in serum calcium is probably equally important.…”