CLINICAL CHARACTERISTICS OF PARATHYROID HORMONE-DEPENDENT HYPERCALCAEMIA

A CASE SERIES ON THE SERDANG EXPERIENCE

Abstract

INTRODUCTION
Primary hyperparathyroidism (PHPT) is characterized by hypercalcaemia with elevated or inappropriately normal parathyroid hormone (PTH) and can be due to parathyroid adenoma, hyperplasia, and carcinoma. The presentation varies from asymptomatic to symptomatic disease with osteoporosis, pancreatitis, and nephrolithiasis. The aim of this review is to look at the common clinical characteristics of PTH-dependent hypercalcaemic patients presented to Serdang Hospital.

METHODOLOGY
Retrospective analysis was performed to identify patients with PTH-dependent hypercalcaemia investigated and managed by the Endocrine Unit of Hospital Serdang from the years 2018 to 2022. Their clinical characteristics, presentations, complications and outcomes of hypercalcaemia were recorded for descriptive analysis.

RESULTS
A total of 13 patients were recorded. Majority of patients with PTH-dependent hypercalcaemia were female (57.14%), with median age of 50 years old (IQR 41-61). Seven (7) out of 13 patients were symptomatic at presentation, with 2 patients presenting with neurological symptoms (fitting and altered mental status). Median corrected serum calcium at presentation was 3.1 mmol/L (IQR 2.9-3.6), phosphate was 0.8 mmol/L (IQR 0.66-0.91), and eGFR was 74.8 ml/min per 1.73m2 (IQR 35.8-97.3). Median level of Vitamin D was 43.16 nmol/L (IQR 29.69-56.12). Positive parathyroid ultrasound (USG) findings were found in 5 out of 13 patients, the results concordant with their sestamibi scans, while another 4 had negative USG but positive sestamibi. Four patients had nephrocalcinosis at diagnosis. Three patients underwent parathyroid operation and histopathology revealed 1 case of parathyroid carcinoma, 1 parathyroid adenoma and 1 parathyroid hyperplasia. 1 case was associated with mediastinal NET, 1 case is PHPT in pregnancy and is awaiting surgery.

CONCLUSION
In conclusion, majority of our PHPT patient in Serdang Hospital have symptomatic disease that is requiring surgery.