Primary Hyperparathyroidism–A Clinical, Biochemical and Radiological Profile with Emphasis on Geographical Variations

Abstract

Clinical, biochemical and radiological features in 12 proven cases of primary hyperparathyroidism in Northern India are described. Occurrence of disease is in the younger age group and skeletal disease is present in 100% in such patients. Epiphyseal changes are recognized and Looser's zone presence indicates an associated vit D deficiency state. Hypercal-ciuria (more than 250 mg 24 hour) however was present in only 33%. On further analysis. alkaline phosphatase was raised markedly and above 40 KA units in 83-6% instances. Chief cell adenomas were present in all instances. In one instance of pluriglandular syndrome, three adenomas have been removed. The phenomenon of hungry bones was met with often in this series. In recognition of skeletal lesions, calcium intake was not often below the minimum recommended intake, e.g. less than 400 mg per 24 hours, nor was the duration of disease too long, e.g. 4-3 years mean duration in this series. It is likely that with a subclinically vit D deficient diet parathormone effect on osteoid is varied. Absence of hypercalcaemia, renal and gastro-intestinal lesions are also indicative of lack of some additive factor to the excessive parathormone occurring in such instances of primary hyperparathyroidism in this geographic area.