PRIMARY HYPERPARATHYROIDISM IN THE YOUNG: COMPARISON WITH THE ADULT PRIMARY HYPERPARATHYROIDISM.

OBJECTIVE

Primary hyperparathyroidism (PHPT) is relatively common among adults; however, rarely encountered in children and adolescents. According to the western literature, young PHPT is different from adult PHPT and is associated with more severe hypercalcaemia. PHPT in adult Indian population is different from its western counterpart. Here we present the clinical, biochemical and surgical characteristics of young PHPT from our tertiary care centre.

METHODS

PHPT patients were divided into adult (age ≥25 years) and young (age <25 years) PHPT groups. The clinical, biochemical, hormonal, histopathological characteristics and treatment outcome of young PHPT patients were compared with adult PHPT patients.

RESULTS

Out of total 358 patients, 47 patients were young and 311 patients were adult PHPT. The mean age of young and adult patients were19±4 and 45±12 years, respectively; with female to male ratio of 1.24:1 and 3.38:1, respectively (p<0.05). The nature and frequency of presenting symptoms were comparable between the two groups. The most common symptom in young PHPT was bone pain, and was not significantly different from adults (57% vs. 61%, respectively). While, the most common symptom in adult PHPT was fatigue, which was also not significantly different from young patients (63% vs. 53% respectively), The serum calcium, phosphate, 25(OH)D, ALP Z-score and PTH levels were comparable between the two groups. Parathyroid adenoma was the commonest histopathological finding, while hyperplasia was rare in both the groups.

CONCLUSIONS

In this series of young PHPT, we observed that young PHPT is not much different from adult counterpart in Indian scenario.

BACKGROUND

ALP = Alkaline phosphatase; Ca = Calcium; Cr = Creatinine; iPTH = Intact parathyroid hormone; MEN1 = Type 1 multiple endocrine neoplasia; MIBI = Methoxy Iso Butyl Isonitrile; P = Phosphate; PHPT = Primary hyperparathyroidism; PTH = Parathyroid hormone; RIPA = Right inferior parathyroid adenoma; PTH = Parathyroid hormone; RIPA = Right inferior parathyroid adenoma; 99mTc sestamibi = Technetium sestamibi; USG = Ultrasonography; 25(OH)D = 25-hydroxy vitamin D.