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OBJECTIVE: Primary hyperparathyroidism (1HPT) is now
being diagnosed with increasing frequency. Simultaneously there
has been an apparent change in the presentation of the disease
and indications for surgery. The aim of this study was to
examine the clinical presentation, indications for surgery, and
outcomes of neck explorations for primary hyperparathyroidism.
METHODS: This study was carried out over a 12 year
period, January 1990 to April 2002 at Jordan University
Hospital, Amman, Jordan. Information on the indications,
procedure performed, pathology and complications of all neck
explorations for 1HPT was obtained from a retrospective
thyroid/parathyroid surgical database. A minimum of 12 months
follow-up was required in order to determine outcome of surgery.
RESULTS: Out of 40 patients diagnosed with primary
hyperparathyroidism at Jordan University Hospital, Amman, over
12 years, 14 patients (35%) diagnosed 4 years after the onset of
their disease. Severe bone disease was the main indication for
surgery in 28 patients; 5 patients with fractured bones, 2
patients with bone cysts, 3 patients with brown tumors and
severe osteoporosis and backache in 22 patients; renal calculi
in 10 patients; muscle ache and weakness in 14 patients; acute
pancreatitis in one patient and asymptomatic HPT following
biochemical screening in one patient. Two patients continued to
have persistent hypercalcemia after the first operation; one of
them has been cured by reoperation for an ectopic parathyroid in
the anterior mediastinum resulting in an overall cure rate of
97.5%.
CONCLUSION: This study showed that severe bone disease
with fractures, bone cysts and brown tumors are still the most
common presentation of primary hyperparathyroidism in Jordan;
this is most likely due to delay in diagnosis and initiation of
treatment. It is important to screen for hyperparathyroidism in
high risk patients and to refer these patients to specialized
centers for proper management.
Institution
Department of Surgery, Jordan University Hospital, PO Box 13024,
Amman, Jordan. niyounes@ju.edu.jo
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