title: Primary hyperparathyroidism: A changing scenario in India.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) is largely a symptomatic disease with varied systemic manifestations, complicated by coexisting Vitamin D (Vit D) deficiency. Increasing awareness, developments in diagnostics, and Vit D supplementation may have an impact on the disease profile of PHPT.
  
  
  METHODS
  Clinical, biochemical, and pathological profile of PHPT presenting to a tertiary care center in South India were compared in two groups separated as per the period of presentation (Group A: January 1994-May 2007 - 51 cases and Group B: June 2007-January 2015 - 59 cases).
  
  
  RESULTS
  PHPT has remained a disease of female preponderance with similar age of presentation. It is being diagnosed earlier (mean duration of symptoms prior to diagnosis was 38.7 months in Group A, significantly longer than 26 months in Group B). Bone pain and metabolic myopathy were the most common presentations (60%) followed by pathological fracture (16%), renal calculi (13%), and pancreatitis (7%). Pathological fractures have become less frequent. Vit D deficiency is still a widespread co-morbidity. Radionuclide scintigraphy is an effective localizing tool, but ultrasound can be an inexpensive and widely available screening modality.
  
  
  CONCLUSIONS
  PHPT still remains asymptomatic disease of bones and stones, although it is being diagnosed early. Greater awareness, Vit D supplementation, and better diagnostic tools have made it a disease with lesser morbidity and effective cure.
authors.affiliation: Department of Endocrinology and Endocrine Surgery, Care Hospital, Hyderabad, Telangana, India.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Jha
authors.affiliation: Department of Endocrinology, Southern Command Hospital, Pune, Maharashtra, India.
authors.forename: Muthukrishnan
authors.initials: M
authors.lastname: Jayaraman
authors.affiliation: Department of Medicine, Medical Intern, MediCiti Hospital, Hyderabad, Telangana, India.
authors.forename: Aman
authors.initials: A
authors.lastname: Jha
authors.affiliation: Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India.
authors.forename: Ratan
authors.initials: R
authors.lastname: Jha
authors.affiliation: Department of Endocrinology and Endocrine Surgery, Care Hospital, Hyderabad, Telangana, India.
authors.forename: Kirtikumar D
authors.initials: KD
authors.lastname: Modi
authors.affiliation: Department of Endocrinology and Endocrine Surgery, Care Hospital, Hyderabad, Telangana, India.
authors.forename: Jayant V
authors.initials: JV
authors.lastname: Kelwadee
keywords: Parathyroid adenoma; Vitamin D deficiency; primary hyperparathyroidism