Management and outcomes of hyperparathyroidism: a case series from a single institution over two decades
Received 27 December 2017
Accepted for publication 30 April 2018
Published 31 July 2018 Volume 2018:14 Pages 1337—1345
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 3
Editor who approved publication: Professor Garry Walsh
Hassan Al-Thani,1 Moamena El-Matbouly,1 Maryam Al-Sulaiti,1 Mohammad Asim,2 Ahmad Majzoub,1 Abdelhakem Tabeb,1 Ayman El-Menyar2,3
1Department of Surgery, Hamad General Hospital, Doha, Qatar; 2Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar; 3Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
Background: Hyperparathyroidism is a frequent endocrine disorder with variable clinical manifestations and outcomes. We aimed to evaluate clinical presentations, management and outcomes of hyperparathyroidism.
Methods: A retrospective study was conducted to include all patients presented with hyperparathyroidism between 1995 and 2014 at a single tertiary hospital with an average follow-up period of 46 months. Data were reviewed for clinical presentations, diagnostic work-up, intraoperative findings, management, and outcomes.
Result: We identified 161 patients with hyperparathyroidism; 69% were females and the mean age was 49.4±15 years. Patients presented mainly with musculoskeletal (65.8%), renal (37.3%), gastrointestinal tract (53.8%) and neuropsychiatric (8.8%) manifestations. At presentation, mean serum calcium and parathyroid hormone levels were elevated while mean vitamin D level was lower. Sestamibi-99mTc (MIBI) scintigraphy was done for 134 patients (83.2%) and was positive in 94 (70%). Primary hyperparathyroidism (67.7%) was the most frequent diagnosis followed by secondary (29.8%) and tertiary hyperparathyroidism (2.5%). The frequent indication for surgery was hypercalcemia (67.3%), bone disease (35.6%) and renal calculi (28.9%). The main postoperative pathology was parathyroid adenoma (63.1%) followed by hyperplasia (37.3%). Fourteen (8.9%) and 18 (11.4%) patients had persistent and recurrent hyperparathyroidism, respectively. Autotransplantation of parathyroid tissue was done in 36 cases.
Conclusion: Primary hyperparathyroidism is the most frequent cause of the parathyroid disease. Parathyroidectomy is the effective surgical approach in symptomatic patients. Further studies are needed to establish the association between vitamin D levels, renal disorders and persistent or recurrent hyperparathyroidism.
Keywords: hyperparathyroidism, parathyroidectomy, renal disorders, Qatar
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