Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism

Balkan Med J. 2017 Jan;34(1):28-34. doi: 10.4274/balkanmedj.2015.0865. Epub 2017 Jan 5.


Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients.

Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions.

Study design: Retrospective, clinical-based multi-centric study of 694 patients with pHPT.

Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease.

Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria.

Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Keywords: Bulgaria; Turkey; clinocopathological features; hyperparathyroidism; regional differences.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biochemical Phenomena*
  • Black Sea / epidemiology
  • Calcium / analysis
  • Calcium / blood
  • Female
  • Hospital Distribution Systems / statistics & numerical data*
  • Humans
  • Hyperparathyroidism, Primary / epidemiology
  • Hyperparathyroidism, Primary / pathology
  • Hyperparathyroidism, Primary / physiopathology*
  • Male
  • Mediterranean Region / epidemiology
  • Middle Aged
  • Parathyroid Hormone / analysis
  • Parathyroid Hormone / blood
  • Retrospective Studies
  • Turkey / epidemiology
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / epidemiology


  • Parathyroid Hormone
  • Calcium