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Changes in Clinical Pattern Over 3 Decades

Chung-Yau Lo, MS(HK), FRCS(Edin), FACS; Wai-Fan Chan, MBBS(HK), FRCS(Edin); Annie W. C. Kung, MD(HK), FRCP; King-Yin Lam, MBBS(HK), FRCPA; Sidney C. F. Tam, MBBS(HK), FRCP; Karen S. L. Lam, MD(HK), FRCP

Arch Surg. 2004;139:77-82.

Hypothesis  With the introduction of the blood chemistry multichannel autoanalyzer, primary hyperparathyroidism (HPT) is increasingly diagnosed. The clinical pattern of primary HPT has undergone a significant evolution in Western countries. A similar change can be documented in a geographic region where this condition is considered to be relatively uncommon.

Design  Unselected case series.

Setting  A tertiary referral endocrine surgical unit.

Patients  All patients with primary HPT surgically treated over the past 30 years.

Main Outcome Measures  The prevalence of patients per 100 000 hospital admissions, clinical presentation, biochemistry study results, pathologic status, and main outcome were compared over three 10-year spans according to the introduction of the multichannel autoanalyzer in 1982: 1973-1982 (n = 20), 1983-1992 (n = 31), and 1993-2002 (n = 190).

Results  A 7-fold increase in the prevalence of patients with primary HPT who were surgically treated per 100 000 hospital admissions was observed over the past 10 years. The clinical presentation of patients with primary HPT had evolved progressively with a higher proportion of older patients (P<.001) being asymptomatic. On presentation, the condition had decreased in severity with lower serum calcium (P = .04), parathyroid hormone (P<.001), and alkaline phosphatase levels (P<.001) as well as a smaller adenoma size (P<.001). There was no significant change in the underlying pathologic condition and surgical success.

Conclusion  Similar to the West but in contrast to that observed in other Asian countries, an increase in the prevalence of patients surgically treated for primary HPT is documented and a change in disease presentation as well as its severity is observed in our population group.

From the Departments of Surgery (Drs Lo and Chan), Medicine (Drs Kung, K. S. L. Lam, and Tam), and Pathology (Dr K. Y. Lam), University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong.

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