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Abstract：
Introduction Primary hyperparathyroidism (PHPT) has undergone a considerable change from being symptomatic to asymptomatic. This is the first large study from North India to study the clinical and biochemical features and surgical outcomes in the present era. Study design This is a cross-sectional study that was conducted in the Department of Endocrinology (SKIMS) from February 2021 to December 2022, in which 103 patients diagnosed with PHPT were included. Evaluation included measurement of total calcium, phosphorus, alkaline phosphate, intact parathyroid hormone, 25-hydroxy vitamin, 24-hour urinary calcium, radiological survey of hands and skull, Dual Energy X-ray absorptiometry, and ultrasonography (USG) of the abdomen. USG neck and technetium-99m sestamibi scans were used for preoperative localization; however, in cases of discordance between these investigations or suspicions of multi-glandular disease, four-dimensional computerized tomography of the neck was used. Patients were subjected to surgery according to the guidelines and monitored post-surgery for complications like hypocalcemia and hungry bone syndrome and to document the cure. Results The mean age of patients was 42.8±14.73 years, with a female-to-male ratio of 4.4:1. The mean eGFR of patients was 99.1±30.87 ml/min, with 55 (53.4%) of them having renal disease. Osteoporosis and fractures were present in 41 (39.8%) and 5 (4.8%) patients, respectively. Cholelithiasis and pancreatitis were present in 25 (24.3%) and 5 (4.9%) patients, respectively. Hypertension (HTN) and diabetes mellitus (DM) were the commonest comorbidities, which were present in 34 (33.1%) and 15 (14.5%) patients, respectively. Mean preoperative levels of calcium, phosphorus (PO4), alkaline phosphate (ALP), intact parathyroid hormone (iPTH), 25(OH)vitamin D, and 24-hour urinary calcium were 12.1 mg/dl, 2.35 mg/dl, 210.2 U/L, 332.9 pg/ml, 25.7 ng/ml, and 452.1 mg/day, respectively. The most common type was right inferior parathyroid adenoma, present in 45 cases (43.7%), followed by left inferior parathyroid adenoma in 31 cases (30.1%). A total of 75 patients (72.8%) underwent minimally invasive parathyroidectomy, with 68 patients (90.7%) achieving a biochemical cure. The mean adenoma weight was 3.19±2.25 g. There was no statistically significant correlation (r) between preoperative biochemical parameters and adenoma weight. Conclusion Despite improvements in imaging and the easy availability of immunoassays for early diagnosis, renal disease continued to be the most common presentation, followed by skeletal involvement in our population. In developing countries like India, any patient presenting with nephrolithiasis or nephrocalcinosis, low bone mass, or fragility fractures should be evaluated for PHPT.
摘要：
引言原发性甲状旁腺功能亢进(PHPT)经历了从有症状到无症状的相当大的变化。这是印度北部首次进行的大型研究，旨在研究当今时代的临床和生化特征以及手术结果。研究设计这是一项横断面研究，于2021年2月至2022年12月在内分泌科（SKIMS）进行，其中包括103例诊断为PHPT的患者。评估包括测量总钙，磷，碱性磷酸盐，完整的甲状旁腺激素，25-羟基维生素,24小时尿钙，手和头骨的放射学检查，双能X射线吸收法,和腹部超声检查（USG）。USG颈部和99msestamibi扫描用于术前定位；然而，在这些调查之间不一致或怀疑多腺病的情况下，使用颈部的四维计算机断层扫描。根据指南对患者进行手术，并在术后监测低钙血症和饥饿骨综合征等并发症，并记录治愈情况。结果患者平均年龄为42.8±14.73岁,男女比例为4.4:1。患者的平均eGFR为99.1±30.87ml/min，其中55人（53.4%）患有肾脏疾病。41例（39.8%）和5例（4.8%）患者出现骨质疏松和骨折，分别。胆石症和胰腺炎分别出现在25例（24.3%）和5例（4.9%）患者中，分别。高血压（HTN）和糖尿病（DM）是最常见的合并症，分别存在于34例(33.1%)和15例(14.5%)患者中，分别。术前平均钙水平,磷（PO4），碱性磷酸盐（ALP），完整的甲状旁腺激素（iPTH），25(OH)维生素D,24小时尿钙为12.1mg/dl，2.35mg/dl,210.2U/L,332.9pg/ml,25.7ng/ml,452.1毫克/天，分别。最常见的类型是右下甲状旁腺腺瘤，45例(43.7%)，其次为左下甲状旁腺腺瘤31例(30.1%)。共有75例（72.8%）患者接受了微创甲状旁腺切除术，68例患者（90.7%）实现生化治愈。平均腺瘤重量为3.19±2.25g。术前生化指标与腺瘤重量之间无统计学意义（r）。结论尽管影像学的改善和早期诊断的免疫测定容易获得，肾脏疾病仍然是最常见的表现，其次是我们人群的骨骼受累。在像印度这样的发展中国家，任何患有肾结石症或肾钙化症的患者，骨量低,或脆性骨折应评估PHPT。
