Primary Hyperparathyroidism is one of the common endocrine disorders seen in an endocrine clinic. We retrospectively analysed patients referred with primary hyperparathyroidism over 1 yr (Oct 2013 - Sept 2014) and followed them over next 30 months. Patients with isolated secondary hyperparathyroidism were excluded. Few had secondary hyperparathyroidism in addition to primary hyperparathyroidism.
50 patients with primary hyperparathyroidism were referred to the endocrine services over 1 yr, out of which 62% (31 patients) were managed conservatively. Of the 50 patients 40% (20 patients) were in 7th decade of their lives, 10% (5 patients) in 8th decade while 16% (8 patients), 14% (7 patients), and 20% (10 patients) were in 4th, 5th and 6th decades respectively. Detailed analysis of the cohort showed that with increasing age there was less likelihood for them to be operated. In 19 patients who had parathyroidectomy, 74% (14 patients) were operated under 70 yrs of age. Only 5% (1 patient) had post-op hypocalcemia while 10% (2 patients) had persistent hypercalcemia. Of the rest of the 31 patients who were not operated only 4% (2 patients) had fractures over the next 30 months- 1 had normocalcemic hyperparathyroidism while the other was not willing for surgery. In the medically managed group, over the 30 months, BMD was not checked in 32% (10 patients- 2 patients (6%) failed to attend followup, 2(6%) moved out of area, 1(3%) died, 3(9%) had mild disease & 2 patients (6%) were still under surveillance), no renal imaging was done in 29% (9 patients) & no 24hr urine calciums were done in 80% (25 patients).
Conclusions: Rates of primary hyperparathyroidism rises with increasing age and not all are required to be operated upon. In accordance with the guidelines for asymptomatic hyperparathyroidism, we saw very less complication rate in terms of fractures but we fell short by not doing 24hr urine calciums & imaging of kidneys for stones in all patients that were not operated.