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ORIGINAL ARTICLE
Year : 2018  |  Volume : 2  |  Issue : 1  |  Page : 22-25

Modes of presentation of primary hyperparathyroidism in Al Hawari General Hospital, Benghazi-Libya


1 Department of Endocrine and Internal Medicine, Faculty of Medicine, Benghazi, Libya
2 Faculty of Medicine, Benghazi University, Benghazi, Libya
3 Department of Medicine, Jamhoryia Hospital, Benghazi, Libya

Correspondence Address:
Dr. Khaled D Alsaeiti
Faculty of Medicine, Benghazi University, Benghazi
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_39_17

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Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in western countries but still predominantly as symptomatic disease in developing countries. The objective of this retrospective study was to describe the modes of presentation of this disease in Benghazi. Patients and Methods: Records of nineteen patients diagnosed with PHPT at metabolic bone disease clinic of Al Hawari general hospital, Benghazi, Libya, during 2005–2012 were reviewed. Results: Mean age at diagnosis was 41.7 ± 11.5 (range 20–70 years). There were 17 females and 2 males with a ratio of 8.5:1. Eighteen patients (94.7%) were symptomatic. Skeletal manifestations were the major mode of presentation in seventeen patients (89.4%) followed by renal stone in one patient (5.3%). All symptomatic patients had a single adenoma, nine of them (47.4%) had right inferior adenomas, and nine had left inferior ones (47.7%), and no adenoma can be detected in asymptomatic patient (5.3%). More than half of the patients had normal serum calcium levels (52.6%) at the time of diagnosis and (47.3%) had persistent hypercalcemia with a mean serum calcium level (10.7 ± 1.02 mg/dL), all patients had high serum intact parathyroid hormone with a mean value of (696.3 ± 379.5 pg/mL), and high serum alkaline phosphatase with a mean level of (901.9 ± 520.8U/L) except one patient who had low level of 20U/L. Vitamin D was measured only in six patients, five of them were a deficit, and one asymptomatic patient had normal level. All our patient's parathyroid adenomas were localized by Ultrasound. Seventeen patients had successful surgery, one patient had a recurrence, and one asymptomatic patient was managed medically according to the Third International Workshop guidelines. Conclusions: PHPT in Libya continues to be a severe, symptomatic disorder with skeletal, and renal manifestations at a much younger age.


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