Primary hyperparathyroidism: King Khalid University Hospital Experience.

BACKGROUND: This study was conducted to examine the prevalence, mode of presentation and management of primary hyperparathyroidism in one of the major hospitals in Saudi Arabia. PATIENTS AND METHODS: This was a retrospective analysis of 24 cases of primary hyperparathyroidism, comprising 21 females and three males, who were seen at King Khalid University Hospital over a period of 16 years from 1982 until December 1997.
RESULTS: The prevalence of the disease was estimated to be 11.34 per 100,000 hospital population. The majority of the patients presented with musculoskeletal complaints (62%-67%) and/or renal complications (58%). Hypercalcemia was seen in 92% of the cases. Serum PTH was available for 21 patients and 20 had significantly elevated levels. Fifty percent of the patients had features of hyperparathyroid bone disease on plain x-ray, while 79% showed osteopenia of the femoral neck on dual x-ray absorptiometry, and almost all the patients had lumbar osteopenia. Fifty percent of the patients had features of metabolic bone disease on bone scan. Thalliumtechnetium subtraction studies proved to be the most reliable tool, with 83% sensitivity, followed by ultrasound scan of the neck, with a sensitivity of 55%. CT scan of the neck was attempted in only seven patients (29%), with a sensitivity of 86%. Twenty-one patients (87.5%) underwent surgical exploration and removal of the parathyroid adenoma. Single parathyroid adenoma was identified in 85% of the cases, 5% had multiple adenomas, and 5% had hyperplasia of the parathyroid gland.
CONCLUSION: Our results showed that primary hyperparathyroidism is not a rare disease in Saudi Arabia. It has a tendency for late presentation with complications. We believe that routine screening for calcium and early identification of such cases are warranted to reduce the morbidity of this easily treatable disorder.