Clinical presentation and outcome of surgical management of primary hyperparathyroidism: A single center-based case series in Egypt

Abstract

Introduction: Primary hyperparathyroidism is an asymptomatic disease in the Western world detected during routine laboratory investigations.The differential diagnosis and the management of primary hyperparathyroidism presenting with more severe symptoms like Skeletal manifestations present a challenge to the surgeon from similar presenting conditions like bone metastases and bone tumors. Objectives: To describe the presentation and the management of primary hyperparathyroidism in the context of limited resources and the challenges faced with the differential diagnosis, especially with the dominance of the skeletal manifestations of the disease. Patients and Methods: Patients presenting with primary hyperparathyroidism during the period from 2010 to 2014 in the National Cancer Institute in Egypt were included in the study. Data were retrieved retrospectively from the files (demographic, pathological, preoperative investigations, surgical approaches, and outcome). Results: In this study, 23 patients were included with an age range of 12–69 years, skeletal manifestations predominated the presentation of the primary hyperparathyroidism in 66.6%, and unilateral neck exploration was the main surgical approach done in 70.8%. The 1-year overall survival is 100% and 1-year relapse-free survival is 92.9%; 17 cases (73.92%) were cured and 6 cases (26.08%) had persistent hyperparathyroidism. Conclusion: The skeletal manifestations predominates primary hyperparathyroidism presentation in this study. The clinician should be aware of the bony manifestations mimicking bone tumors and metastatic tumors to the bone. Calcium and parathyroid hormone levels should be done first before attempting excision of the tumor, especially if it involves the maxilla or mandible. Surgery is curative for symptomatic cases in different age groups with low incidence of complications, recurrence, and persistence of the disease.