Primary hyperparathyroidism

OBJECTIVE: The aim of the study is to present the clinical pattern, surgical indication and management of primary hyperparathyroidism in a teaching hospital in the Kingdom of Saudi Arabia (KSA).

METHODS: The records of patients who underwent surgical treatment for primary hyperparathyroidism at the King Khalid University Hospital, Riyadh, KSA from March 1992 to October 2002 were reviewed for epidemiological data, biochemical, radiological investigation, operative procedures, histopathology result, preoperative localization studies included neck ultrasonogram, neck computerized tomography and thallium-technetium subtraction scan. All patients underwent surgery under general anesthesia and procedures were bilateral, unilateral neck exploration, or minimal invasive parathyroidectomy.

RESULTS: A total of 41 patients with diagnosis of primary hyperparathyroidism were reviewed. There were 30 females and 11 males with a mean age of 42 years (range 14-78 years). The musculoskeletal symptoms were the major symptoms in 30 patients (73%) followed by renal stone in 6 patients (14.6%), peptic ulcer in 2, acute pancreatitis in one, asymptomatic patients accounted for 5% (2 patients) and the thallium-technetium scan has the highest sensitivity rate (89%) among the preoperative localization studies. The histopathological results showed adenoma in 36 cases (87.8%), hyperplasia in 3 cases (7.3%) and no pathology found in 2 cases.

CONCLUSION: Almost all the patients presented with late symptoms and complications of primary hyperparathyroidism, the number of asymptomatic patients, is low due to lack of routine serum calcium check up. Owing to the high sensitivity of thallium-technetium scan and the relatively low incidence of hyperplasia (7.3%), we believe that unilateral neck exploration guided by preoperative scan is a suitable procedure for primary hyperparathyroidism.