Symptomatic Primary Hyperparathyroidism

Lee, Jaebok; Lee, Eunsuk; Bae, Chungwon; Koo, Bumhwan

Abstract

BACKGROUND: Primary hyperparathyroidism is a relatively frequent disease in western countries. The rate of occurrence in Korea is increasing due to increased concern of people and the development of imaging techniques.
METHODS
The purpose of this study is to evaluate the clinical characteristics of patients with primary hyperparathyroidism by a retrospective analysis of their medical records.
RESULTS
19 patients with symptomatic hyperparathyroidism underwent a parathyroidectomy from Dec. 1987 to Aug. 1997 at the Department of Surgery, Korea University Hospital. The mean age of the patients was 44.6 years old, and the male-to-female ratio is 7:12. The major symptoms were generalized weakness (47.4%), polydipsia (36.8%), neck mass (36.8%), and arthralgia (15.8%) in order of frequency. Associated conditions during admission were urinary tract stones (21.1%), thyroid nodules (15.8%), degenerative osteoarthritis (10.5%), and pathologic fracture (10.5%). The mean duration of the major symptom of hyperparathyroidism was 20.6 months. The level of preoperative serum calcium was 13.2+/-2.1 mg, and that of the ionized calcium was 5.8+/-0.7 mg/dl. The level of serum parathormone was greatly higher than the standard value of hospital laboratory (687.2 pg/ml, reference value: 9~55 pg/ml). The true positive rates of imaging study were 78.9% of the hand and skull plain films, 71.4% of the neck CT scans, 40.0% of the neck sonograms, 80.0% of the Tl-c subtraction scans and 100% of the Sestamibi scans. One enlarged parathyroid gland was removed in each of 18 cases and two glands were removed in 1 case. The pathologic types of the enlarged glands were adenomas (16 cases), carcinomas (2 cases), and hyperplasia (1 case). The mean size of the parathyroid tumors was 2.2 cm X 1.7 cm X 1.2 cm, and the mean weight was 7.7 gram. Postoperative hypocalcemia developed in 15 patients and was the most severe on postoperative 3rd day.
CONCLUSION
There was 20.6 months interval from the onset of patients' symtoms to the time of parathyroidectomy. Endocrine surgeons should pursue detecting the operable parathyroid tumors and remind medical endocrinologists that the best way of localizing parathyroid tumors is through an operation.