Sir,
I read with interest the case report on primary hyperparathyroidism presenting as recurrent pancreatitis.[1] It serves to emphasize the symptomatic presentation of the condition in India in contrast to that in West. Studies from different parts of the country have established that symptomatic predominates over asymptomatic presentation of primary hyperparathyroidism.[2–5]
I want to bring to your attention a recent case of symptomatic primary hyperparathyroidism which presented as bilateral maxillary swelling to our institution. She was a 40-year-old lady who had classical biochemical features of primary hyperparathyroidism. Technetium (99 mTc) sestamibi scan localized the parathyroid adenoma to left inferior gland and whole-body bone scan [Figure 1] was suggestive of metabolic bone disease with evidence of brown tumors in bilateral maxilla and left iliac bone. Parathyroidectomy was done and biochemical features normalized following treatment of “Hungry bone syndrome.” The brown tumors are expected to regress with time. Myriad symptomatic presentations of this condition are relatively common and lie undocumented in India.
Figure 1.
Tc-99m MDP whole-body bone scan of patient with primary hyperparathyroidism
REFERENCES
- 1.Misgar RA, Mathew V, Pandit K, Chowdhury S. Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature. Indian J Endocrinol Metab. 2011;15:54–6. doi: 10.4103/2230-8210.77588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Bhansali A, Masoodi SR, Somashekara-Reddy KS, Behera A, Radotra BD, Mittal BR, et al. Primary hyperparathyroidism in north India: A description of 52 cases. Ann Saudi Med. 2005;25:29–35. doi: 10.5144/0256-4947.2005.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Priya G, Jyotsna VP, Gupta N, Chumber S, Bal CS, Karak AK, et al. Clinical and laboratory profile of primary hyperparathyroidism in India. Postgrad Med J. 2008;84:34–9. doi: 10.1136/pgmj.2007.062653. [DOI] [PubMed] [Google Scholar]
- 4.Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J. Unique clinical characteristics of primary hyperparathyroidism in India. Br J Surg. 2001;88:708–14. doi: 10.1046/j.0007-1323.2001.01775.x. [DOI] [PubMed] [Google Scholar]
- 5.Gopal RA, Acharya SV, Bandgar T, Menon PS, Dalvi AN, Shah NS. Clinical profile of primary hyperparathyroidism from western India: A single center experience. J Postgrad Med. 2010;56:79–84. doi: 10.4103/0022-3859.65279. [DOI] [PubMed] [Google Scholar]