Primary hyperparathyroidism: clinical presentation and management

Nineteen patients with primary hyperparathyroidism were operated upon in the period from January 1994 till December 1998. Thirteen patients were females and six were males. The maximum age incidence occurred in the fourth decade. Bony lesions were the frequent presentation. They were in the form of localized pain and bone swelling [38.8%], pathological fracture [26.3%] and generalized bone ache [10.5%]. The diagnosis of primary hyperparathyroidism was established on basis of elevated levels of ionized calcium, 24-hours urinary caclium and PTH together with decreased levelof serum phosphorus. Preoperative ultrasonography correctly localized the parathyroid pathology in 73.7%. Bilateral exporation of the neck revealed a sizable solitary parathyroid adenoma in 18 patients. In a single case the adenoma was intra thyroid in location. A concomitant partial throidectomy was performed in 7 patients. The postoperative complications were trivial; 11 patients suffered from transient hypercalcaemia. The determined postoperative serum calcium and PTH were normalized although both attained a different pattern to do this after operation. Among the 15 patients presenting with bone cysts, only two were treated surgically. The majority responded to conservative treatment adopting rest and immobilization after parathyroid adenectomy. Moreover, the pathological fractures healed well conservatively after the adenectomy. Internal fixation was resorted to in only 2 cases having pathological fractures of the femur

Parathyroid allotransplantation in patients with post-thyroidectomy severe hypocalcemia without antirejection therapy

In this study, 10 patients with manifestations of severe hypoparathyroidism were treated with allograft transplantation of parathyroid tissue from unrelated donors. Prednisolone was given one day preoperatively and was maintained for two days after operation. In the first two weeks after transplantation, gradual elevation of the serum calcium level was noticed in most of the patients and it was maintained for a period of three months. From this study, it was shown that allotransplantation of the parathyroid gland is a very effective method to improve the symptoms and lessen the medications of patients with post thyroidectomy manifestations of hypoparathyroidism