Skip to main content

Advertisement

Log in

Primary hyperparathyroidism: insights from the Indian PHPT registry

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

The presentation of primary hyperparathyroidism (PHPT) is variable throughout the world. The present study explored retrospective data submitted to the Indian PHPT registry (http://www.indianphptregistry.com) between July 2005 and June 2015 from 5 centres covering four different geographical regions. The clinical, biochemical, radiological and histopathological characteristics of PHPT patients across India were analysed for similarity and variability across the centres. A total of 464 subjects (137 men and 327 women) with histopathologically proven PHPT were analysed. The mean age was 41 ± 14 years with a female:male ratio of 2.4:1. The majority (95%) of patients were symptomatic. Common clinical manifestations among all the centres were weakness and fatigability (58.7%), bone pain (56%), renal stone disease (31%), pancreatitis (12.3%) and gallstone disease (11%). Mean serum calcium, parathyroid hormone and inorganic phosphorus levels were 11.9 ± 1.6 mg/dL, 752.4 ± 735.2 pg/mL and 2.8 ± 0.9 mg/dL, respectively. Sestamibi scanning had better sensitivity than ultrasonography in the localisation of parathyroid adenoma; however, when these two modalities were combined, 93% of the cases were correctly localised. Mean parathyroid adenoma weight was 5.6 ± 6.5 g (0.1–54 g). It was concluded that the majority of PHPT patients within India are still mainly symptomatic with >50% of patients presenting with bone disease and one-third with renal impairment. Compared to Western countries, Indian patients with PHPT are younger, biochemical abnormalities are more severe, and adenoma weight is higher. As our observation is largely derived from a tertiary care hospital (no routine screening of serum calcium level), the results do not reflect racial differences in susceptibility to PHPT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fraser WD (2009) Hyperparathyroidism. Lancet 374:145–158

    Article  CAS  Google Scholar 

  2. Bhansali A, Masoodi SR, Reddy KS, Behera A, Das Radotra B, Mittal BR, Katariya RN, Dash RJ (2005) Primary hyperparathyroidism in north India: a description of 52 cases. Ann Saudi Med 25:29–35

    Article  Google Scholar 

  3. Bilezikian JP, Meng X, Shi Y, Silverberg SJ (2000) Primary hyperparathyroidism in women: a tale of two cities−New York and Beijing. Int J Fertil Womens Med 45:158–165

    CAS  PubMed  Google Scholar 

  4. Shah VN, Bhadada S, Bhansali A, Behera A, Mittal BR (2014) Changes in clinical & biochemical presentations of primary hyperparathyroidism in India over a period of 20 years. Indian J Med Res 139:694–699

    PubMed  PubMed Central  Google Scholar 

  5. Marcocci C, Cetani F (2011) Clinical practice. Primary hyperparathyroidism. N Engl J Med 365:2389–2397

    Article  CAS  Google Scholar 

  6. Bhadada SK, Bhansali A, Dutta P, Behera A, Chanukya GV, Mittal BR (2008) Characteristics of primary hyperparathyroidism in adolescents. J Pediatr Endocrinol Metab 21:1147–1153

    Article  CAS  Google Scholar 

  7. Gopal RA, Acharya SV, Bandgar T, Menon PS, Dalvi AN, Shah NS (2010) Clinical profile of primary hyperparathyroidism from western India: a single center experience. J Postgrad Med 56:79–84

    Article  CAS  Google Scholar 

  8. Muthukrishnan J, Jha S, Modi KD, Jha R, Kumar J, Verma A, Harikumar KV, Patro K, Srinivas B, Kumaresan K, Ramasubba R (2008) Symptomatic primary hyperparathyroidism: a retrospective analysis of fifty one cases from a single centre. J Assoc Phys India 56:503–507

    CAS  Google Scholar 

  9. Priya G, Jyotsna VP, Gupta N, Chumber S, Bal CS, Karak AK, Seth A, Ammini AC (2008) Clinical and laboratory profile of primary hyperparathyroidism in India. Postgrad Med J 84:34–39

    Article  CAS  Google Scholar 

  10. Pradeep PV, Mishra A, Agarwal G, Agarwal A, Verma AK, Mishra SK (2008) Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency. World J Surg 32:829–835

    Article  CAS  Google Scholar 

  11. Shah VN, Bhadada SK, Bhansali A, Behera A, Mittal BR, Bhavin V (2012) Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 58:107–111

    Article  CAS  Google Scholar 

  12. Shah VN, Bhadada SK, Bhansali A, Behera A, Bhattacharya A, Nahar U, Bhasin D, Vadera B (2014) Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism. Indian J Med Res 139:279–284

    PubMed  PubMed Central  Google Scholar 

  13. Kapur MM, Agarwal MS, Gupta A, Misra MC, Ahuja MM (1985) Clinical & biochemical features of primary hyperparathyroidism. Indian J Med Res 81:607–612

    CAS  PubMed  Google Scholar 

  14. Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J (2001) Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg 88:708–714

    Article  CAS  Google Scholar 

  15. Mack LA, Pasieka JL (2004) Asymptomatic primary hyperparathyroidism: a surgical perspective. Surg Clin North Am 84:803–816

    Article  Google Scholar 

  16. Mithal A, Kaur P, Singh VP, Sarin D, Rao DS (2015) Asymptomatic primary hyperparathyroidism exists in North India: retrospective data from 2 tertiary care centers. Endocr Pract 21:581–585

    Article  Google Scholar 

  17. Zhao L, Liu JM, He XY, Zhao HY, Sun LH, Tao B, Zhang MJ, Chen X, Wang WQ, Ning G (2013) The changing clinical patterns of primary hyperparathyroidism in Chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab 98:721–728

    Article  CAS  Google Scholar 

  18. Harinarayan CV, Gupta N, Kochupillai N (1995) Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol (Oxf) 43:351–358

    Article  CAS  Google Scholar 

  19. Malabu UH, Founda MA (2007) Primary hyperparathyroidism in Saudi Arabia: a review of 46 cases. Med J Malaysia 62:394–397

    CAS  PubMed  Google Scholar 

  20. Rao DS, Wilson RJ, Kleerekoper M, Parfitt AM (1988) Lack of biochemical progression or continuation of accelerated bone loss in mild asymptomatic primary hyperparathyroidism: evidence for biphasic disease course. J Clin Endocrinol Metab 67:1294–1298

    Article  CAS  Google Scholar 

  21. Parfitt AM, Rao DS, Kleerekoper M (1991) Asymptomatic primary hyperparathyroidism discovered by multichannel biochemical screening: clinical course and considerations bearing on the need for surgical intervention. J Bone Miner Res 6(suppl 2):S97–101 (discussion S121–S124)

    PubMed  Google Scholar 

  22. Ingemansson SG, Hugosson CH, Woodhouse NJ (1988) Vitamin D deficiency and hyperparathyroidism with severe bone disease. World J Surg 12:517–521

    Article  CAS  Google Scholar 

  23. Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR, Talpos GB, Parfitt AM (2000) Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 85:1054–1058

    CAS  PubMed  Google Scholar 

  24. Varshney S, Bhadada SK, Saikia UN, Sachdeva N, Behera A, Arya AK, Sharma S, Bhansali A, Mithal A, Rao SD (2013) Simultaneous expression analysis of vitamin D receptor, calcium-sensing receptor, cyclin D1, and PTH in symptomatic primary hyperparathyroidism in Asian Indians. Eur J Endocrinol 169:109–116

    Article  CAS  Google Scholar 

  25. Varshney S, Bhadada SK, Sachdeva N, Arya AK, Saikia UN, Behera A, Rao SD (2013) Methylation status of the CpG islands in vitamin D and calcium-sensing receptor gene promoters does not explain the reduced gene expressions in parathyroid adenomas. J Clin Endocrinol Metab 98:E1631–E1635

    Article  CAS  Google Scholar 

  26. Mundy GR, Cove DH, Fisken R (1980) Primary hyperparathyroidism: changes in the pattern of clinical presentation. Lancet 1:1317–1320

    Article  CAS  Google Scholar 

  27. Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV et al (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 4:283–291

    Article  CAS  Google Scholar 

  28. Jacob JJ, John M, Thomas N, Chacko A, Cherian R, Selvan B, Nair A, Seshadri M (2006) Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg 76:740–744

    Article  Google Scholar 

  29. Bhansali A, Masoodi SR, Bhadada S, Mittal BR, Behra A, Singh P (2006) Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery. Clin Endocrinol (Oxf) 65:340–345

    Article  CAS  Google Scholar 

  30. Casas AT, Burke GJ, Sathyanarayana Mansberger AR Jr, Wei JP (1993) Prospective comparison of technetium-99 m-sestamibi/iodine-123 radionuclide scan versus high-resolution ultrasonography for the preoperative localization of abnormal parathyroid glands in patients with previously unoperated primary hyperparathyroidism. Am J Surg 166:369–373

    Article  CAS  Google Scholar 

  31. Soin AS, Gupta S, Kochupillai N, Sharma LK (1994) Primary hyperparathyroidism—an Indian study. Indian J Cancer 31:72–77

    CAS  PubMed  Google Scholar 

  32. Sathe PA, Madiwale CV, Kandalkar BM, Bandgar TR, Shah NS, Menon PS (2009) Primary hyperparathyroidism: a clinicopathological experience. Indian J Pathol Microbiol 52:313–320

    Article  Google Scholar 

  33. Agarwal G, Prasad KK, Kar DK, Krishnani N, Pandey R, Mishra SK (2006) Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg 30:732–742

    Article  Google Scholar 

  34. Brown S, O’Neill C, Suliburk J, Sidhu S, Sywak M, Gill A, Robinson B, Delbridge L (2011) Parathyroid carcinoma: increasing incidence and changing presentation. ANZ J Surg 81:528–532

    Article  Google Scholar 

  35. Lee PK, Jarosek SL, Virnig BA, Evasovich M, Tuttle TM (2007) Trends in the incidence and treatment of parathyroid cancer in the United States. Cancer 109:1736–1741

    Article  Google Scholar 

  36. Wang TS, Ostrower ST, Heller KS (2005) Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery 138:1130–1135 (discussion 1135–1136)

    Article  Google Scholar 

  37. Stewart ZA, Blackford A, Somervell H, Friedman K, Garrett-Mayer E, Dackiw AP, Zeiger MA (2005) 25-hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy. Surgery 138:1018–1025 (discussion 1025–1026)

    Article  Google Scholar 

Download references

Acknowledgments

We profusely acknowledge Dr. Sudhaker D Rao, Bone and Mineral Research laboratory, Henry Ford Hospital, Detroit, USA for his immense contribution to develop Indian PHPT registry program. We thank Dr. Viral Shah for generating data from Indian PHPT patients. We also like to thank Dr. Pinaki Dutta, Dr. Rama Walia, Dr. Ashu Rastogi, Dr. Arunanshu Behera and Dr. BR Mittal for their contribution in patient management and thanks to all patients for their participation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sanjay Kumar Bhadada.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding

None.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhadada, S.K., Arya, A.K., Mukhopadhyay, S. et al. Primary hyperparathyroidism: insights from the Indian PHPT registry. J Bone Miner Metab 36, 238–245 (2018). https://doi.org/10.1007/s00774-017-0833-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-017-0833-8

Keywords

Navigation