Experience of Surgical Treatment for Primary Hyperparathyroidism

Kim, Kyung Ho; Park, Chong Dae; Hong, Suck Joon

Abstract

PURPOSE
The number of patients diagnosed with primary hyperparathyroidism has been increased owing to the routine biochemical screening of serum calcium since 1970's in the western countries as well as recently in Korea. However, the absolute number of surgically treated patients in Korea is still smaller than other developed countries in the incidence wise, and this could indicate the tendency of relatively late diagnosis and treatment of primary hyperparathyroidism in Korea. This study was performed to investigate the clinical character and post operative results of surgically treated Korean patients.
METHODS
80 primary hyperparathyroidism patients surgically treated at Asan Medical Center from Jan 1996 to August 2002 were reviewed retrospectively.
RESULTS
The etiological proportion of the primary hyperparathyroidism (single adenoma 80%, hyperplasia or multiple adenoma 10%, MENI 9%, cancer 1%) was similar to the western countries. However, the proportion of the symptomatic patients (82%) to the asymptomatic patients (18%) was much higher compared to the recent data of western countries. 41 patients (single adenoma 36 case, hyperplasia 4 cases, cancer 1case) were followed up more than 3 months after surgery with monitoring the serum calcium and i-PTH. In 23 patients (44%), their i-PTH level was above normal range more than once during follow up period without hypercalcemia. The postoperative serum calcium level was lower and the preoperative i-PTH level was higher in these patients significantly compared to the patients with normal postoperative i-PTH level. The tumor size tended to be larger in these patients but statistically insignificant. These results suggest that these patients had more severe hyperparathyroidism.
CONCLUSION
The proportion of the patients who were symptomatic and has persistent post operative high i-PTH level suggesting severe hyperparathyroidism was relatively high compared to the western countries. Earlier diagnosis and treatment is demanded in Korea.