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ABSTRACT
Purpose: We aimed to report demographic and clinical characteristics of patients with primary hyperparathyroidism (pHPT) that we followed up in order to share our clinical experience.
Material and Method: 171 patients, who were followed up between March 2008 and July 2010 in our Endocrinology and Metabolic Diseases Clinic with the diagnosis of PHPT, were included in the study. Serum total calcium (Ca+2), phosphorus (P), albumin, creatinine, parathormone (PTH), 25-hydroxyvitamine D3, results of ultrasonography (US), 24-hour Ca+2, P and creatinine measurements, 99mTc-sestamibi (MIBI), single photon emission tomography (SPECT), magnetic resonance imaging (MRI), bone mineral densitometer, urinary US, treatments that were administered as well as postoperative pathological results of the patients, were evaluated.
Results: Of the 171 patients, 137 were women (80,1%) and 34 were men (19,9%). The mean age of the patients was 55.3±11.6 years (25-80), and the mean serum total Ca+2 was 11.3±0.8 mg/dl, P was 2.6±0.5 mg/dl, PTH was 27.9±33.6 pmol/L, 25-hydroxyvitamine D3 was 13.5±12.3 ng/ml, 24 hour urine Ca+2 was 350.8±277.2 mg. 34 (19,9%) patients had nephrolithiasis while 96 (56,1%) had osteoporosis. In three patients, PHPT was the component of multiple endocrine neoplasia syndromes. Parathyroid pathology was detected in 84.2% of patients by US, in 61.0% by MIBI, in 66.4% by SPECT, and in 55.3% using MRI. While the most common location for parathyroid adenoma was the left lower lob of parathyroid (50.0%), ectopic (mediastinal) parathyroid adenoma was detected in 2.9% of patients. Pathological analysis revealed adenoma in 89.7%, hyperplasia in 4.4% and carcinoma in 1.5% of patients. In six patients (4,4%), no lesion was detected at surgery.
Discussion: As a result of the routine measurements of calcium levels in many centers, the incidence of asymptomatic PHPT seems to be increased. Surgery is the only definitive treatment for primary hyperparathyroidism. Widespread use of imaging techniques increases the success rate of surgery.