Primary Hyperparathyroidism in Iran: A Review

Over the past half century, the pattern of clinical presentation of primary hyperparathyroidism (PHPT) has changed dramatically in Western countries; indeed it has evolved from a severe disease to an asymptomatic condition. The story is completely different in Eastern countries, where PHPT still presents with the traditional pattern of bones and stones. The aim of the pre-sent review is to analyze Iranian experiences in the clinical, biochemical, radiological, and pathological findings of PHPT and to compare these features with those of patients from devel-oped and developing nations. Materials and Methods: An extensive search of PHPT literature was carried out. Of the relevant publications from 1980-2006 (3 international, 3 local) five yielded compressive data in large se-ries of Iranian patients. The information was evaluated, analyzed, summarized and compared to that of patients from other Eastern and West-ern countries. Results: A total of 356 patients were included in these studies; there were 317 females and 49 males, age range 11 to 72 years, mean age 38.2±12.4 years with a female to male ratio of 6.4 to 1. Most patients presented with advanced skeletal involvement. Nephrolithiasis was diag-nosed in 14–47% patients. Majority of patients had high serum PTH and low serum phosphorus levels; nearly all displayed some radiological changes suggestive of hyperparathyroid bone disease. Osteoporosis, subperiosteal bone re-sorption, salt and pepper appearance, brown tu-mor and pathologic fractures were frequent x-ray findings. Single adenoma was discovered in most patients. There were few cases with para-thyroid carcinoma. Mean parathyroid gland weight, reported in 177 cases, was 4.1 grams, (range 0.8 – 25 grams). Conclusion: PHPT is a severe, symptomatic dis-ease with serious complications and high mor-bidity in Iran. Advanced skeletal disease is the most common pattern of presentation at a young age.