Spectrum of parathyroid disorders in Pakistan: a review article

Abstract

Parathyroid abnormalities and gland diseases are classified as hyperparathyroidism and hypoparathyroidism. These conditions are often discovered incidentally during screenings for abnormal serum calcium levels, typically conducted for renal or bone diseases and other disorders. Parathyroid hormone (PTH) plays a crucial biological role in maintaining ionized calcium and phosphate levels within the normal range by activating specific receptor-mediated cell responses throughout the body. Compared to the Western world, Pakistan has significantly fewer publications on parathyroid diseases. Most available research comprises case reports, small case series, or retrospective studies, often including approximately 100 studies. In this article, we describe the demographics and varied clinical presentations of parathyroid gland disorders in the Pakistani population. Additionally, we provide a summary of biochemical parameters and localization strategies used in these cases. A compiled record of parathyroid gland disorders in Pakistan is currently lacking, and this article aims to bridge that gap by presenting a comprehensive review of all reported cases. This review includes a summary of 54 studies, comprising retrospective studies and case reports, highlighting the clinical variability of parathyroid (PTH) disorders in Pakistan. According to the literature, 0.5% of patients were asymptomatic, while the mean duration of symptoms among symptomatic patients was 3.03 years. Unlike Western populations, laboratory findings from Pakistani patients show elevated levels of serum calcium, serum PTH, and serum alkaline phosphate. Common clinical features included abdominal pain, dysphagia, and vitamin D deficiency, along with constitutional symptoms such as arthralgias, myalgias, fatigue, and headache. Psychiatric complications, particularly clinical depression, and pathological fractures emerged as the most frequent complications associated with PTH disorders in Pakistan.

Keywords: hyperparathyroidism; hypoparathyroidism; parathyroid hormone; parathyroidectomy.