Primary Hyperparathyroidism: A Report on 30 Cases of the Disease

Primary hyperparathyroidism is not nowadays considered a rare disease and according to some reports, its incidence is 1/1000. This disorder can be accompanied with severe complications including renal failure and bone illnesses and this can highly elevate the treatment costs and causes social problems and troubles within families. The descriptive strategy of this study was carried out on 30 patients with primary hyperparathyroidism and it was attempted to demonstrate its clinical symptoms, paraclinical signs, and radiological findings and to compare it with the related data of other western countries and in this way to propose recommendations for rapid diagnosis and appropriate management of the patients. The results showed that the most common clinical findings were bone pains, renal stone, weight loss and generalized weakness. In addition, nearly half of them were confined to bed. The average time elapsed to make a definite diagnosis was 5.8 ± 5 years. Radiologic findings showed reduced mineralization, subperiosteal bone resorption, salt and pepper appearance for cranial bones and bone fracture in 93, 86, 76, 60 and 47% of cases. Furthermore, the level of serum calcium, phosphorus, alkaline phosphatase and the patient's PTH divided by upper limit of normal PTH were 11.2 ± 1.3 mg%, 2.2 ± 0.5 mg%, 1346 ± 1335 IU/1 and 4.2 ± 2.8 respectively. Pathologic findings verified solitary adenoma in 25% of cases, double adenoma in I case, four­gland hyperplasia in 2 of the cases and two cases of parathyroid cancer. It is concluded that manifestations of patients with primary hyperparathyroidism are different from those residing in western countries. Since routine measurment of serum calcium is not available and the patients are diagnosed when the disease has progressed far advanced, then it is better to keep it in mind that differential diagnosis of patients with bone pain and renal stone should be made to establish the diagnosis earlier and prevent the ensuing complications.