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

Pages : 28-34

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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