VARIED CLINICAL MANIFESTATIONS OF PRIMARY HYPERPARATHYROIDISM

Abstract

Objective: The objective of this study was to evaluate the clinical manifestations of patients who presented with primary hyperparathyroidism (PHPT).

Methods: This three-year retrospective study was conducted in the Endocrinology department of the Hayatabad Medical Complex, Peshawar. Data of PHPT patients was taken from hospital records between Jan 1, 2020, and Dec 30, 2023. Both male and female patients with PHPT who 18 years of age were or older and had undergone parathyroid surgery were included in the study. Patients with secondary or tertiary hyperparathyroidism, multiple endocrine neoplasia, and those with hypercalcemia from malignancies other than parathyroid carcinoma were excluded.   

Results: A total of 55 patients with PHPT were identified, of whom, there were 31 (56.4%) males and 24 (43.6%) females. The mean age of the study participants was 38.8 years.   Majority of the patients had musculoskeletal manifestations (40%). This was followed by renal calculi (30.9%). Gastrointestinal manifestations and neurological features were the presenting symptoms in 5 (9.1%) and 1 (1.8%) patient respectively. PHPT was found to be asymptomatic in 2 (3.6%) patients.  There was statistically significant difference in the mean serum calcium, phosphorus and PTH levels between patients with different clinical manifestations (p <0.001).

Conclusion: This study reported a high frequency of musculoskeltal and renal manifestations in patients with PHPT. Arthralgias, back pain, myalgias, muscle weakness and fractures were common skeletal manifestations, while nephrolithiasis was a common renal manifestation. This reiterates the importance of high clinical suspicion of PHPT in patients presenting with these symptoms.