Anisuddin Bhatti, Ghulam Mehboob, M. Saeed Minhas, Asadullah Khan.
Overt Bone Disease in Primary Hyperparathyroidism and Role of Screening.
J Coll Physicians Surg Pak Jan ;10(7):235-41.

During the last six years 121 patients were screened for Primary hyperparathyroidism (H.P.T.) at an early stage of disease so as to prevent further deterioration of skeletal lesions and systemic complications. Patients having severe osteopenia and associated symptoms of arthralgia, polyostotic pain, bone swellings and pathological fractures due to any cause other than tumour or infection were screened. The screening tools included clinical history and examination, radiological survey, serum protein, serum calcium, phosphorus, alkaline phosphatase estimation and Tc99 bone scan. Of these 121 screened patients only 20 were suspected to have primary HAT and were later confirmed by biochemical markers. Out of these seven patients had normal serum calcium while thirteen had moderate to severe hypercalcemia. However, all the patients had significantly raised serum alkaline phosphatase and paratharmone levels. Seventeen were found to had hyperfunctioning parathyroid gland on scintiscan; whereas, three had negative scintiscan. Parathyroidectomy in all the 17 patients confirmed primary HPT Biopsy reports confirmed single gland adenoma in 14 patients, hyperplasia in two and carcinoma of parathyroid in one patient. Postoperatively, 8 patients developed tetany, all the patient improved subjectively within 48 hours. The cystic lesions disappeared in 4 to 16 weeks and fractures healed in 4 to 6 months. None of the patient developed recurrence or persistent disease.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com