Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India
- 33 Downloads
Most of the cases of PHPT in developing countries present in symptomatic stage, some even in very advanced stage but in recent years the trend seems to be changing. This has been corroborated from few recently published literature from developing countries. The scope of this study is to further carry out an in-depth analysis of various clinical and biochemical parameters of PHPT patients at a tertiary care center of northern India.
In this retrospective analysis, a total of 333 patients with PHPT from the year 1990 to 2016 were studied. The study population was divided into three subgroups based on the time span; 1990–1999 (n = 34), 2000–2009 (n = 112), 2010–2016 (n = 187), and clinical and biochemical parameters were compared.
The clinical presentation has evolved progressively with increase in older age group (35 vs 39 vs 43.85, p < 0.001), less patients with musculoskeletal symptoms (85.3 vs 76.8 vs 61%, p = 0.002) and less patients with severe bone disease (29.4 vs 10.7 vs 10.7%, p = 0.088). Biochemical parameters also showed a changing trend with significant decrease in mean S. Alkaline phosphatase (1393 vs 965 vs 414.8 IU/L, p < 0.001) and S. iPTH (837.52 vs 812.89 vs 635.74 pg/mL, p = 0.02). Vitamin D nutrition status is still suboptimal but shows improvement, and more patients are insufficient as compared to previous deficient state (mean S. Vitamin D—10.31 vs 16.16 vs 25.30 ng/mL, p < 0.001).
Our study reveals a change in trend in PHPT which is similar to evolution of this disease in western population and positively corroborated with observations from China, Hong Kong and Turkey.
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Sanjay Kumar Yadav, Saroj Kanta Mishra, Anjali Mishra helped in literature search, figures, study design, data collection, data analysis, data interpretation and writing. Sabaretnam Mayilvagnan, Gyan Chand, Gaurav Agarwal, Amit Agarwal, Ashok Kumar Verma helped in revision and editing of manuscript.
Compliance with ethical standards
Conflict of interest
All the authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed written consent was obtained from the patient.
- 8.Agarwal G, Prasad KK, Kar DK, Krishnani N, Pandey R, Mishra SK (2006) Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg 30(5):732–742. https://doi.org/10.1007/s00268-005-0366-5 CrossRefPubMedGoogle Scholar
- 14.Eufrazino C, Veras A, Bandeira F (2013) Epidemiology of primary hyperparathyroidism and its non-classical manifestations in the city of Recife, Brazil. Clin Med Insights: Endocrinol Diabetes 6:69–74Google Scholar
- 19.Ambrogini E, Cetani F, Cianferotti L, Vignali E, Banti C, Viccica G, Oppo A, Miccoli P, Berti P, Bilezikian JP, Pinchera A, Marcocci C (2007) Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab 92(3114–21):6Google Scholar
- 20.Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T (2007) Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab 92(1687–92):7Google Scholar
- 21.Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89(5415–22):8Google Scholar
- 22.Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93(3462–70):9Google Scholar
- 23.Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, Varhaug JE, Hessman O, Rosen T, Nordenstrom J, Jansson S, Hellstrom M, Bollerslev J (2015) Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. J Clin Endocrinol Metab 100:1359–1367CrossRefPubMedGoogle Scholar
- 25.Zhao Lin, Liu Jian-min, He Xiao-Yan, Zhao Hong-yan, Sun Li-hao, Tao Bei, Zhang Min-jia, Chen Xi, Wang Wei-qing, Ning Guang (2013) The changing clinical patterns of primary hyperparathyroidism in chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab 98(2):721–728CrossRefPubMedGoogle Scholar
- 27.Bahrami A (2008) Primary hyperparathyroidism in Iran: a review. Int J Endocrinol Metab 1:50–57Google Scholar
- 29.Government of India (2014) National health policy draft. Ministry of Health and Family Welfare, Government of India, New DelhiGoogle Scholar
- 31.Ghosh S (2014) Publicly-financed health insurance for the poor understanding RSBY in Maharashtra. Econ Polit Wkly 49:93–99Google Scholar
- 38.Raue F, Jacubeit T, Minne H, Herfarth C, Ziegler R (1989) Primary hyperparathyroidism–changes in the disease picture. Med Klin (Munich) 84(4):178–182Google Scholar