Primary hyperparathyroidism: a review of 177 cases

Abstract

Background: We designed a comprehensive study to explore different aspects of primary hyperparathyroidism in a series of Iranian patients. Our study aimed to elucidate the demographic, pathologic, biochemical, and surgical findings of these patients.

Material/methods: In a retrospective study from 1981 to 2003, we reviewed records of 177 patients operated on with the diagnosis of primary hyperparathyroidism in Shariati Hospital. Patients with secondary or tertiary hyperparathyroidism and those being re-operated were excluded.

Results: 88.1% of the lesions were adenoma, 9.6% hyperplasia, and 1 case proved to be carcinoma. In 1.7% of patients, no pathologic gland(s) were found. The majority of patients were female (female-to-male ratio: 5.5) and their mean age was 41.9+/-13.6 years. Most of the patients (77.6%) had mild hypercalcemia, and the mean calcium level was 11.2+/-0.8 mg/dl prior to surgery. Patients with hyperplasia had lower calcium levels than patients with adenoma 24 hours post-operation, with mean calcium levels of 8.1+/-1.2 mg/dl versus 9.03+/-1.2 mg/dl, respectively (p=0.02). Mean weight of adenomas was 4.1 gram (range 0.8-25 g). Adenomas were mostly (74%) located in lower parathyroid glands and 6.3% of them were ectopic.

Conclusions: Primary hyperparathyroidism should be expected at younger ages in Iran. Parathyroid hyperplasia in a patient should alert the surgeon of the higher risk of postoperative hypocalcemia.