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Progressive rise in the prevalence of asymptomatic primary hyperparathyroidism in India: Data from PHPT registry

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Abstract

Introduction

Primary hyperparathyroidism (PHPT), a third common endocrine disorder, varies from asymptomatic disease, mostly seen in the West where routine biochemical screening is practiced, to the classical symptomatic disease mostly seen in the Eastern countries. We aimed to compare the demographic, clinical, biochemical measurements in patients with asymptomatic and symptomatic PHPT from the Indian PHPT registry.

Material and methods

Data of PHPT patients from the last 25 years (1995–2019) were analyzed for demographic, clinical presentation and biochemical measurements, and compared these characteristics between asymptomatic and symptomatic PHPT patients.

Results

Of the 554 patients, 54 (10%) patients had asymptomatic PHPT. There was a sharp rise in the proportion of asymptomatic PHPT patients of 3% in the first decade to 13% in the second decade of the century (p = 0.003). Patients with asymptomatic PHPT were significantly older (50 vs. 42 years; p < 0.0001) and had higher mean body mass index (27.8 vs. 23.5 kg/m2; p < 0.0001) compared to the symptomatic PHPT group. In addition, asymptomatic PHPT patients had significantly lower median plasma iPTH (180 vs. 370 pg/mL; p < 0.0001), serum alkaline phosphatase (119 vs. 172 IU/L; p < 0.0001), and parathyroid adenoma weight (1.0 vs. 2.62 g; p = 0.006) compared to the symptomatic PHPT group.

Conclusion

Although symptomatic PHPT is still most prevalent (> 90%) in India with higher indices of the disease and tumor weights, there is a progressive rise in the prevalence of asymptomatic PHPT patients in the last decade. Improvements in calcium and vitamin D nutrition might account for this change as in the Western series.

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References

  1. Fraser WD (2009) Hyperparathyroidism. Lancet 374:145–158

    CAS  PubMed  Google Scholar 

  2. Wermers RA, Khosla S, Atkinson EJ, Achenbach SJ, Oberg AL, Grant CS et al (2006) Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Miner Res 21:171–177

    PubMed  Google Scholar 

  3. Bilezikian JP, Rubin M, Silverberg SJ (2006) Asymptomatic primary hyperparathyroidism. Arq Bras Endocrinol Metabol 50:647–656

    PubMed  Google Scholar 

  4. Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VC et al (2014) Bone disease in primary hyperparathyroidism. Arq Bras Endocrinol Metabol 58:553–561

    PubMed  PubMed Central  Google Scholar 

  5. Shah VN, Bhadada S, Bhansali A, Behera A, Mittal B (2014) Changes in clinical and biochemical presentations of primary hyperparathyroidism in India over a period of 20 years. Indian J Med Res 139:694–699

    PubMed  PubMed Central  Google Scholar 

  6. Gopal RA, Acharya SV, Bandgar T, Menon PS, Dalvi AN, Shah NS (2010) Clinical profile of primary hyperparathyroidism from western India: a single center experience. J Postgrad Med 56:79–84

    CAS  PubMed  Google Scholar 

  7. Bhadada SK, Arya AK, Mukhopadhyay S, Khadgawat R, Sukumar S, Lodha S et al (2018) Primary hyperparathyroidism: insights from the Indian PHPT registry. J Bone Miner Metab 36:238–245

    CAS  PubMed  Google Scholar 

  8. Hu S, Cai X, Mewani V, Wong B, Trooskin S, Wang X (2016) Impact of ethnic background on clinical characteristics and cardiovascular risk factors among patients with primary hyperparathyroidism. Endocr Pract 22:323–327

    PubMed  Google Scholar 

  9. Shah VN, Bhadada SK, Bhansali A, Behera A, Mittal BR, Bhavin V (2012) Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 58:107–111

    CAS  PubMed  Google Scholar 

  10. Jacob JJ, John M, Thomas N, Chacko A, Cherian R, Selvan B et al (2006) Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg 76:740–744

    PubMed  Google Scholar 

  11. Kapur MM, Agarwal MS, Gupta A, Misra MC, Ahuja MM (1985) Clinical and biochemical features of primary hyperparathyroidism. Indian J Med Res 81:607–612

    CAS  PubMed  Google Scholar 

  12. Jha S, Jayaraman M, Jha A, Jha R, Modi KD, Kelwadee JV (2016) Primary hyperparathyroidism: a changing scenario in India. Indian J Endocrinol Metab 20:80–83

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Sathe PA, Madiwale CV, Kandalkar BM, Bandgar TR, Shah NS, Menon PS (2009) Primary hyperparathyroidism: a clinicopathological experience. Indian J Pathol Microbiol 52:313–320

    PubMed  Google Scholar 

  14. Pradeep PV, Jayashree B, Mishra A, Mishra SK (2011) Systematic review of primary hyperparathyroidism in India: the past, present, and the future trends. Int J Endocrinol 2011:921814

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Arya AK, Bhadada SK, Mukherjee S, Singh P, Rana SS, Dahiya D et al (2018) Frequency and predictors of pancreatitis in symptomatic primary hyperparathyroidism. Indian J Med Res 148:721–727

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Mukherjee S, Bhadada SK, Arya AK, Singh P, Sood A, Dahiya D et al (2018) Primary hyperparathyroidism in the young: comparison with adult primary hyperparathyroidism. Endocr Pract 24:1051–1056

    PubMed  Google Scholar 

  17. Singh P, Vadi SK, Saikia UN, Sood A, Dahiya D, Arya AK et al (2019) Minimally invasive parathyroid carcinoma—a missing entity between parathyroid adenoma and carcinoma: scintigraphic and histological features. Clin Endocrinol (Oxf) 91:842–850

    CAS  Google Scholar 

  18. Zhao L, Liu JM, He XY, Zhao HY, Sun LH, Tao B et al (2013) The changing clinical patterns of primary hyperparathyroidism in Chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab 98:721–728

    CAS  PubMed  Google Scholar 

  19. Sun B, Guo B, Wu B, Kang J, Deng X, Zhang Z et al (2018) Characteristics, management, and outcome of primary hyperparathyroidism at a single clinical center from 2005 to 2016. Osteoporos Int 29:635–642

    CAS  PubMed  Google Scholar 

  20. Mithal A, Kaur P, Singh VP, Sarin D, Rao DS (2015) Asymptomatic primary hyperparathyroidism exists in North India: retrospective data from 2 tertiary care centers. Endocr Pract 21:581–585

    PubMed  Google Scholar 

  21. Rao DS, Honasoge M, Divine GW, Phillips ER, Lee MW, Ansari MR et al (2000) Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 85:1054–1058

    CAS  PubMed  Google Scholar 

  22. Rao DS, Agarwal G, Talpos GB, Phillips ER, Bandeira F, Mishra SK et al (2002) Role of vitamin D and calcium nutrition in disease expression and parathyroid tumor growth in primary hyperparathyroidism: a global perspective. J Bone Miner Res 17(Suppl 2):N75–N80

    CAS  PubMed  Google Scholar 

  23. Harinarayan CV, Gupta N, Kochupillai N (1995) Vitamin D status in primary hyperparathyroidism in India. Clin Endocrinol (Oxf) 43:351–358

    CAS  Google Scholar 

  24. Parfitt AM, Rao DS, Kleerekoper M (1988) Screening for primary hyperparathyroidism. Ann Intern Med 108:151–152

    CAS  PubMed  Google Scholar 

  25. Silverberg SJ, Bilezikian JP (2006) The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab 2:494–503

    PubMed  Google Scholar 

  26. Bilezikian JP, Khan AA, Potts JT Jr (2009) Third International Workshop on the Management of Asymptomatic Primary H. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 94:335–339

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L et al (2017) Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 28:1–19

    CAS  PubMed  Google Scholar 

  28. Bandeira F, Griz L, Caldas G, Bandeira C, Freese E (2006) From mild to severe primary hyperparathyroidism: the Brazilian experience. Arq Bras Endocrinol Metabol 50:657–663

    PubMed  Google Scholar 

  29. Mallikarjuna VJ, Mathew V, Ayyar V, Bantwal G, Ganesh V, George B et al (2018) Five-year retrospective study on primary hyperparathyroidism in South India: emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography-computed tomography scan. Indian J Endocrinol Metab 22:355–361

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Ogo A, Sakaki Y, Saito R, Sakamoto R, Matoba Y (2014) A pilot study to examine the management of asymptomatic hyperparathyroidism in Japanese patients in accordance with the guidelines for asymptomatic PHPT proposed at the Third International Workshop in 2008. Intern Med 53:1749–1754

    PubMed  Google Scholar 

  31. Prasarttong-Osoth P, Wathanaoran P, Imruetaicharoenchoke W, Rojananin S (2012) Primary hyperparathyroidism: 11-year experience in a single institute in Thailand. Int J Endocrinol 2012:952426

    PubMed  PubMed Central  Google Scholar 

  32. Kobayashi T, Sugimoto T, Chihara K (1997) Clinical and biochemical presentation of primary hyperparathyroidism in Kansai district of Japan. Endocr J 44:595–601

    CAS  PubMed  Google Scholar 

  33. Makay O, Ozcinar B, Simsek T, Arici C, Gungor B, Ozbas S et al (2017) Regional clinical and biochemical differences among patients with primary hyperparathyroidism. Balkan Med J 34:28–34

    PubMed  PubMed Central  Google Scholar 

  34. Siddiqui MI, Pasha HA, Asad R, Talati JJ (2019) Changing paradigms in the surgical management of hyperparathyroidism at a tertiary care hospital in a developing country. J Pak Med Assoc 69:1360–1364

    PubMed  Google Scholar 

  35. Tay YK, Khoo J, Chandran M (2016) Surgery or no surgery: What works best for the kidneys in primary hyperparathyroidism? A study in a multi-ethnic Asian population. Indian J Endocrinol Metab 20:55–61

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Saponaro F, Cetani F, Repaci A, Pagotto U, Cipriani C, Pepe J et al (2018) Clinical presentation and management of patients with primary hyperparathyroidism in Italy. J Endocrinol Investig 41:1339–1348

    CAS  Google Scholar 

  37. Aresta C, Passeri E, Corbetta S (2019) Symptomatic hypercalcemia in patients with primary hyperparathyroidism is associated with severity of disease, polypharmacy, and comorbidity. Int J Endocrinol 2019:7617254

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Silverberg SJ, Walker MD, Bilezikian JP (2013) Asymptomatic primary hyperparathyroidism. J Clin Densitom 16:14–21

    PubMed  PubMed Central  Google Scholar 

  39. Walker MD, Cong E, Lee JA, Kepley A, Zhang C, McMahon DJ et al (2015) Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation. J Clin Endocrinol Metab 100:3443–3451

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Rao DS, Phillips ER, Divine GW, Talpos GB (2004) Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab 89:5415–5422

    CAS  PubMed  Google Scholar 

  41. Locchi F, Tommasi M, Brandi ML, Tonelli F, Meldolesi U (1997) A controversial problem: is there a relationship between parathyroid hormone level and parathyroid size in primary hyperparathyroidism? Int J Biol Mark 12:106–111

    CAS  Google Scholar 

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Acknowledgements

No fund was received for conducting the study.

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Authors and Affiliations

  1. Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Ashutosh Kumar Arya, Poonam Kumari, Sanjay Kumar Bhadada, Kanhaiya Agrawal, Priyanka Singh & Soham Mukherjee

  2. Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Ashwani Sood

  3. Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, USA

    Sudhaker D. Rao

Authors
  1. Ashutosh Kumar Arya
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  2. Poonam Kumari
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  3. Sanjay Kumar Bhadada
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  4. Kanhaiya Agrawal
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  5. Priyanka Singh
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  6. Soham Mukherjee
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  8. Sudhaker D. Rao
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Correspondence to Sanjay Kumar Bhadada.

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Ethical approval

The study was approved by the Institutional Ethics committee, Postgraduate Institute of Medical Education and Research, Chandigarh India (INT/IEC/2016/2254 dated 27-09-2016). Informed written consent was obtained from all study participants. The study was carried out in accordance with the approved institutional and international research ethics guidelines.

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Arya, A.K., Kumari, P., Bhadada, S.K. et al. Progressive rise in the prevalence of asymptomatic primary hyperparathyroidism in India: Data from PHPT registry. J Bone Miner Metab 39, 253–259 (2021). https://doi.org/10.1007/s00774-020-01142-w

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  • DOI: https://doi.org/10.1007/s00774-020-01142-w

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