Abstract
Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.
Highlights
Primary hyperparathyroidism (PHPT) is a disease characterized by hypercalcemia due to autonomous production of parathyroid hormone (PTH)
The reasons for higher incidence of osteitis fibrosa cystica (OFC) in Indian patients could be due to Vitamin D (Vit D) deficiency together with the fact that there is a delay in seeking medical attention and, a delay in diagnosis
The immediate postoperative period is turbulent in Indian PHPT patients due to Hungry bone syndrome (HBS), postoperative pancreatitis [17, 39], sepsis, multiorgan failure, metabolic disturbances related to the end-stage renal disease, and thrombophlebitis related to intravenous calcium infusions
Summary
Primary hyperparathyroidism (PHPT) is a disease characterized by hypercalcemia due to autonomous production of parathyroid hormone (PTH). India, PHPT is still an uncommonly diagnosed, overtly symptomatic disease of “bones, stones, abdominal groans, and psychic moans.”. This may be because of the fact that, in India, screening of the healthy population for hypercalcemia is not a routine practice and there is limited access to medical treatment, especially in the rural areas. Contemporary series of patients with PHPT from developed nations are largely dominated by elderly females with mild to moderate hypercalcemia and very few with classical symptoms [3], contrary to the clinical picture seen in developing countries, especially India. We explored the methods which would possibly change the present trend, so as to diagnose more cases at an asymptomatic stage in order to decrease the morbidity and mortality seen in Indian patients with PHPT
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