Primary hyperparathyroidism due to parathyroid adenoma

OBJECTIVE: To evaluate the clinical characteristics and outcome of patients with parathyroid adenoma.

METHODS: We diagnosed and operated 54 patients with primary hyperparathyroidism in the Faculty of Medicine, Gazi University, Turkey from January 2000 to December 2004. In this study, 52 (96.2%) of these patients who had parathyroid adenoma were retrospectively evaluated.

RESULTS: There were 46 female, and 6 male patients with a median age of 54.5 years (range, 18-87 years) at diagnosis. Preoperative mean serum level of calcium was 11.09 ± 0.9 mg/dL, while phosphorus was 2.3 ± 0.5 mg/mL, and parathyroid hormone (PTH) was 338.99 ± 416.43 pg/ml. Ultrasound imaging revealed parathyroid adenoma in 38 of the 52 patients (73%), while 27% of the patients were normal. In 29 (69%) of the 42 patients who had sestamibi scanning, results revealed parathyroid adenoma and in the others (31%), sestamibi scanning was normal. On the postoperative period, the mean serum calcium level was 9.2± 0.74 mg/dL (p=0.0001 compared to preoperative level), phosphorus was 2.7 ± 0.39 mg/mL (p=0.07 compared to preoperative level), and PTH level was 41.01 ± 43.03 pg/ml (p=0.0001 compared to preoperative level). All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period.

CONCLUSION: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and PTH levels are the most useful parameters for diagnosis. Preoperative screening methods and operative findings are not always correlated so the patients with high serum calcium and PTH should be planned for surgery, independent of radiological results. All patients were cured after operation, as determined by normalization in serum calcium levels in the postoperative period.