title: Pathological fracture: a common presentation of primary hyperparathyroidism in Iraq.
abstract: OBJECTIVE
  To describe our experience with severe primary hyperparathyroidism.
  
  
  METHODS
  Prospective open study.
  
  
  METHODS
  City hospital, Iraq.
  
  
  METHODS
  15 patients with confirmed severe hyperparathyroidism operated on during the period 1985-92.
  
  
  METHODS
  Neck exploration was performed for all patients.
  
  
  METHODS
  Morbidity, mortality, and outcome.
  
  
  RESULTS
  The peak incidences were in the age groups 20-29. 10 patients presented with pathological fractures. Plasma parathyroid hormone concentrations were raised in all 15 patients. 14 patients had solitary adenomas, and the remaining one had three adenomas. One patient developed persistent hypocalcaemia that required permanent vitamin D supplementation, and 12 patients developed transient postoperative hypocalcaemia and were treated with calcium and vitamin D supplements either orally or intravenously until they were free of symptoms. Two patients died postoperatively, one of respiratory failure and one of haemorrhage from a bleeding duodenal ulcer.
  
  
  CONCLUSIONS
  Primary hyperparathyroidism is an underdiagnosed disorder in Iraq, and most patients present with advanced disease. Surgical treatment is indicated and the results are good.
authors.affiliation: Department of Surgery, Medical City Hospital, Baghdad, Iraq.
authors.forename: T E
authors.initials: TE
authors.lastname: Sawa
authors.forename: S B
authors.initials: SB
authors.lastname: Safar
mesh_terms: D000236:Adenoma / Q000150:complications; D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D002648:Child; D005260:Female; D005598:Fractures, Spontaneous / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium