ISSN : 2146-3123
E-ISSN : 2146-3131

Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism
Maria Stamatin 1, Özer Makay 2, Beyza Özçınar 3, Turgay Şimşek 4, Cumhur Arıcı 5, Bülent Güngör 6, Serdar Özbaş 7, Tamer Akça 8, Ali Uğur Emre 9, Güldeniz Karadeniz Çakmak 9, Müfide Akçay 10, Bülent Ünal 11, Mustafa Girgin 12, Sadullah Girgin 13, Semih Görgülü 14
1Regional Neonatal Intensive Care Unit, Division of Neonatology, Department of Mother and Child Care, Grigore T. Popa University of Medicine and Pharmacy, Cuza-Voda Clinical Hospital of Obstetrics and Gynaecology, Iasi, Romania
2Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey
3Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
4Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
5Department of General Surgery, Division of Endocrine Surgery, Akdeniz University School of Medicine, Antalya, Turkey
6Department of General Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
7Department of General Surgery, Güven Hospital, Ankara, Turkey
8Department of General Surgery, Division of Endocrine Surgery, Mersin University School of Medicine, Mersin, Turkey
9Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
10Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey
11Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
12Department of General Surgery, Fırat University School of Medicine, Elazığ, Turkey
13Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
14Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey
15Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
DOI : 10.4274/balkanmedj.2015.0865

Abstract

Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients.
Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions.

Study Design: Retrospective, clinical-based multi-centric study of 694 patients with pHPT.
Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease.
Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria.
Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

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Keywords : Hyperparathyroidism, clinocopathological features, regional differences, Turkey, Bulgaria
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