Clinical spectrum of primary hyperparathyroidism

Objective: Primary hyperparathyroidism (1HPT) is now diagnosed with increasing frequency .Aim of study was to examine the clinical presentation , indications for surgery , and outcomes of neck explorations for (1HPT). Methods; study was carried out at Jordan University Hospital,Amman, Jordan from January 1990 to April 2002.A minimum of 12 months follow up was required to determine the outcome of surgery. Results: Out of 40 patients diagnosed with 1HPT , 14 patients (35%) diagnosed 4 years after the disease .Severe bone disease was the main indication for surgery in 28 patients; 5 patients with fractured bones, 2 patients with bone cyst,3 patients with brown tumors ,renal calculi in 10 patients , muscle ache and weakness in 14 patients acute pancreatitis in 1 patient and asymptomatic HPT following biochemical screening in 1 patient.2 patients continued to have persistent hypercalcaemia after the first operation; one of them has been cured by re operation for an ectopic parathyroid in the anterior mediastinum resulting in an overall cure rate of 95.7%. Conclusion showed severe bone disease with fractures, bone cyst and brown tumors are still the most common presentation of (1HPT)in Jordan.It is important to screen for hyperparathyroidism in high risk patients and to refer these patients to specialized centers for proper management. (author)