Bone and renal stone disease in patients operated for primary hyperparathyroidism in Pakistan: Is the pattern of disease different from the West?

Objective: To document the clinical presentation of primary hyperparathyroidism (PHPT) in a developing country and note differences from the West. Setting: A tertiary care teaching hospital. Method: The records of 37 patients operated for PHPT between January 1986 and December 1997 were reviewed. Symptoms, laboratory parameters and histopathology results were analyzed. Results: Surgery for PHPT accounted for 0.055% of 67,566 operative procedures performed in the Department of Surgery during the 12 year period. The mean age of our patients was 38.4±13.2 years (range 17 to 73 years). Ninety percent of patients were less than 60 years old and 51% less than 40 years. At presentation, the mean serum parathyroid hormone (sPTH) level was 618±741% abvoe the upper limit of normal (range 0-2900% using a variety of assays). A solitary adenoma was present in 86.5%, hyperplasia in 5.4% and carcinoma in 5.4% of patients. There was one (2.7%) negative exploration. Thirty-five percent of patients had renal stone disease (StD), 32.4% had bone disease alone (BD) and 27% had both bone abnormality and stones (BStD). There were neither bone disease nor stones in 5.4% of patients. BD was associated with a statistically non-significantly (p=O.O8) higher alkaline phosphatase level (sALP) as compared to the StD and BStD groups. The mean urinary calcium (Ca) was higher in the BD group (482±340 mg/24 hours) as compared to StD group (265±89 mg/24 hours) (pO.Ol3). The post-operative hospital stay was longer in the BD group (14.4±16 days) as compared to the StD group (6.7±3.7 days) (p=0.001). Conclusion: As compared to reports from the Western world, PHPT is less commonly diagnosed in our country and occurs at a younger age. In the absence of a screening programme, symptomatic disease and bone involvement occur more frequently. The high levels of PTH may indicate long-standing disease in our population, which may account for higher proportion of patients with symptoms. Unexpectedly. patients with bone disease had higher levels of urinary calcium than patients with stone disease (JPM A 49:194, 1999)