Moghira Iqbal Siddiqui, Hamdan Ahmed Pasha, Rayaan Asad, Jamsheer Jehangir Talati.
Changing paradigms in the surgical management of hyperparathyroidism at a tertiary care hospital in a developing country.
J Pak Med Assoc Jan ;69(9):1359-63.

We report the presentation, management and outcomes of patients operated for hyperparathyroidism at our hospital. Patients undergoing surgery for hyperparathyroidism from 2005 to 2015 were retrospectively reviewed. Preoperative biochemistry, diagnostic scans and surgical procedures were studied. Follow up for cure rates, complications and histology were recorded. Out of 72 patients reviewed 54 (75%) were females and the rest males. The mean age was 48.04+-15.5 years. Musculoskeletal complains were the most common (76.4%) among the cases reviewed. Asymptomatic hypercalcemia was seen in 13 (18.1%). The mean preoperative PTH level was 658.95 pg/ml and the mean preoperative calcium was 11.9 mg/dl. Bilateral neck exploration was done in 42 (58.3%) while focused unilateral approach was done in 27 (37.5%) cases. Solitary adenoma was the most frequent pathology in 58 (80.5%) patients. Asymptomatic hyperparathyroidism was less frequently detected in our population owing to lack of screening programme. Our patients are younger with a greater severity of the disease both symptomatically and biochemically compared to the West. In almost two decades, preoperative symptoms, calcium and PTH levels have changed marginally. Bilateral explorations are now giving way to focused less invasive procedures.

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