Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease

ABSTRACT While the developed world is focusing on laying guidelines for selecting out cases of Asymptomatic primary hyperparathyroidism (PHPT) for surgical intervention and promoting minimal access surgery, the developing world is observing a change in disease spectrum from advanced symptomatic to lesser degree of symptomatic disease and not many with associated Vitamin D deficiency. Few studies from the developing countries of the world have focused on the changing clinical spectrum of PHPT. Objective of this study is to review the changing profile of PHPT in developing world. A systematic literature search was done in December 2017 focussing on publications from the developing world. All studies pertaining to the epidemiology of PHPT published after 1st January 2000 and published in English language were included for analysis. Most of the studies published from developing countries report a predominance of symptomatic disease (79.6% of all included patients) with musculoskeletal disease present in the majority of patients (52.9%). The combined mean serum total calcium (11.9 ± 1.4 mg/dL), serum PTH (668.6 ± 539 pg/mL), serum alkaline phoshpatase (619 ± 826.9 IU/L) and weight of excised parathyroid glands (4.4 ± 3.8 grams) are much higher than those reported from the western studies. Despite this, we found that there is a distinct trend towards a milder form of disease presentation and biochemical profile noticeable in more recent times. Although there is a striking difference in all aspects of PHPT disease epidemiology, clinical presentation and biochemical profile of developing and developed countries, there is a distinct trend towards a milder form of disease presentation and biochemical profile in more recent times.

摘要 发达国家目前正致力于制定无症状性原发性甲状旁腺功能亢进症（asymptomatic primary hyperparathyroidism, PHPT）的手术干预病例筛选指南，并推广微创外科手术；而发展中国家则正经历疾病谱的转变：从重度有症状型疾病转向轻度有症状型疾病，且合并维生素D缺乏症的患者比例较低。目前全球范围内针对发展中国家PHPT临床谱变化的研究较为匮乏。本研究旨在综述发展中国家PHPT的疾病特征变化情况。本研究于2017年12月开展系统性文献检索，聚焦发展中国家的相关文献，最终纳入2000年1月1日后发表的、以英文撰写的所有PHPT流行病学相关研究进行分析。多数发展中国家的相关研究显示，有症状型PHPT占比最高（纳入患者的79.6%），且多数患者合并肌肉骨骼病变（占比52.9%）。纳入研究的患者血清总钙均值（11.9±1.4 mg/dL）、血清甲状旁腺激素（parathyroid hormone, PTH）均值（668.6±539 pg/mL）、血清碱性磷酸酶均值（619±826.9 IU/L）以及切除甲状旁腺的平均重量（4.4±3.8克）均显著高于西方同类研究的报道结果。尽管存在上述差异，但研究发现近年来发展中国家PHPT的疾病表现与生化特征呈现出明显的轻症化趋势。尽管发展中国家与发达国家在PHPT的流行病学、临床表现及生化特征各方面均存在显著差异，但近年来前者的疾病表现与生化特征同样呈现出明显的轻症化趋势。