Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK
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ORIGINAL ARTICLE
Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre Joseph M Pappachan Ian M Lahart4
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Mohamed Nabil Elnaggar1,2 Ravinder Sodi3 Kahtan Jbeili1 Paul R Smith1 ●
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Received: 21 April 2018 / Accepted: 2 July 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Background Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom. Methods Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT. Results The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5). Conclusions PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT. Keywords Primary hyperparathyroidism Parathyroidectomy Hypercalcaemia Osteoporosis Acute kidney injury ●
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Introduction * Joseph M Pappachan [email protected] 1
Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster LA1 4RP, UK
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Internal Medicine Department, Faculty of Medicine,
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