Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHP) is the result of excessive, independent, and inappropriate production of parathyroid hormone (PTH). The aim of this work is to study the epidemiological, clinico-biological and therapeutic aspects of PHP.

Materials and methods: This is a retrospective study of 34 patients hospitalized for the management of PHP in the Endocrinology Department of the Military Hospital of Tunis between March 1999 and July 2018.

Results: The average age of our patients was 59 years old with female predominance (sex ratio=0.37). PHP was asymptomatic in 57% of patients and fortuitously discovered by systematic measurement of serum calcium. The diagnosis was biological: elevated PTH with hypercalcemia or normo-calcemia. Parathyroid ultrasonography/scintigraphy, performed in 90% and 83% of patients respectively, made it possible to locate the pathological parathyroid(s), with a concordant result in 65% of cases. CT/MRI imaging was used in 23.5% of cases, with 6% of patients found to have ectopic mediastinal parathyroid adenoma. Complications were mainly found in kidneys and bone: kidney stones (37%) and osteoporosis (40%). The treatment was in all cases surgical, essentially a subtotal adenomectomy or parathyroidectomy except for cases of ectopic parathyroid nodule, which were addressed in Cardio Thoracic Surgery.

Discussion and conclusion: The signs of hypercalcemia are rarely indicative of PHP but rather sought after positive biological diagnosis. Imaging plays a key role in preoperative diagnosis and surgical approach.