Abstract 29: Primary hyperparathroidism in Kerala – A single centre experience

Introduction: The clinical spectrum in primary hyperparathyroidism (PHPT) though varied has undergone a striking change in developed countries with predominant asymptomatic PHPT detected during routine biochemical screening for other causes. Recent data from India showed that PHPT still presents with classic skeletal and renal manifestations. In this study we analyzed the clinical presentation, investigations, management, operative findings, and immediate post-operative course of patients with histologically proven PHPT at our centre. Aim: To study the clinical and biochemical presentation of Hyperparathyroidism (HPT) Materials and Methods: Patients diagnosed to have newly diagnosed primary hyperparathyroidism were studied. All patients underwent biochemical investigations including Calcium, Phosphorous, Alkaline Phosphatase, Albumin, 25-OH vitamin D, Parathyroid hormone, Creatinine, Urine calcium/creatinine ratio, BMD and Parathyroid scan. The period of the study was from September [2013] 2016 to June [2019] 2021. Results: Out of the 40 patients studied 26 patients were female and 14 were male. 18 patients were incidentally detected during screening. The mean age was 42.7 ± 12.4. The mean calcium level was 11.5 ± 1.8 mg/dl, Phosphate was 2.8 ± 0.87 mg/dl. Mean PTH value was 206.4 ± 74.2 pg/ml. 2 Patients had brown tumor on skeletal survey. The mean BMD was -3.6 ± 0.8 (femur neck), -3.9 ± 0.86 (spine), -3.9 ± 0.7 (forearm). The cause of hyperparathyroidism included single adenoma in 22 patients, double adenoma in 8 patients, triple adenoma in 2 patients, ectopic adenoma (mediastinal) in 2 patients' hyperplasia in 6 patients. 3 patients had MEN1 syndrome. 5 patients had familial HPT (3 MEN1 associated). Conclusion: Hyperparathyroidism in Kerala resembles the disease trend seen in the developed countries, then the rest of India, with more cases being picked up incidentally in the asymptomatic stage. Renal calculi are a very common presentation of hyperparathyroidism in our study. Fracture of bones and brown tumors were rare in our study, probably due to the early diagnosis.