title: Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.
abstract: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients.
  
  
  
  To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions.
  
  
  
  Retrospective, clinical-based multi-centric study of 694 patients with pHPT.
  
  
  
  Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease.
  
  
  
  The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria.
  
  
  
  Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey.
authors.forename: Özer
authors.initials: Ö
authors.lastname: Makay
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
authors.forename: Beyza
authors.initials: B
authors.lastname: Özçınar
authors.affiliation: Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: Turgay
authors.initials: T
authors.lastname: Şimşek
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Cumhur
authors.initials: C
authors.lastname: Arıcı
authors.affiliation: Department of General Surgery, Ondokuz Mayıs University School of Medicine, Samsun, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Güngör
authors.affiliation: Department of General Surgery, Güven Hospital, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Özbaş
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Mersin University School of Medicine, Mersin, Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Akça
authors.affiliation: Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Ali Uğur
authors.initials: AU
authors.lastname: Emre
authors.affiliation: Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Güldeniz
authors.initials: G
authors.lastname: Karadeniz Çakmak
authors.affiliation: Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey.
authors.forename: Müfide
authors.initials: M
authors.lastname: Akçay
authors.affiliation: Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Ünal
authors.affiliation: Department of General Surgery, Fırat University School of Medicine, Elazığ, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Girgin
authors.affiliation: Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey.
authors.forename: Sadullah
authors.initials: S
authors.lastname: Girgin
authors.affiliation: Department of General Surgery, Gülhane Training and Research Hospital, Ankara, Turkey.
authors.forename: Semih
authors.initials: S
authors.lastname: Görgülü
authors.affiliation: Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey.
authors.forename: Atakan
authors.initials: A
authors.lastname: Sezer
authors.affiliation: Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Karataş
authors.affiliation: Department of General Surgery, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey.
authors.forename: İbrahim Ali
authors.initials: İA
authors.lastname: Özemir
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.affiliation: Department of General Surgery, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Erel
authors.affiliation: Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: M Ümit
authors.initials: MÜ
authors.lastname: Uğurlu
authors.affiliation: Department of General Surgery, Okan University School of Medicine, Istanbul, Turkey.
authors.forename: Ali İlker
authors.initials: Aİ
authors.lastname: Filiz
authors.affiliation: Department of General Surgery, Ankara Oncology Training Hospital, Ankara, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Atalay
authors.affiliation: Department of General Surgery, Harran University School of Medicine, Şanlıurfa, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Uzunköy
authors.affiliation: Department of Gernral Surgery, Sultan Abdülhamid Training and Research Hospital, İstanbul, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Deveci
authors.affiliation: Department of General Surgery, Yüzüncü Yıl University School of Medicine, Van, Turkey.
authors.forename: Çetin
authors.initials: Ç
authors.lastname: Kotan
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Ege University School of Medicine, İzmir, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: İçöz
authors.affiliation: Department of Gernral Surgery, Sultan Abdülhamid Training and Research Hospital, İstanbul, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Kurt
authors.affiliation: Department of General Surgery, Okan University School of Medicine, Istanbul, Turkey.
authors.forename: Abut
authors.initials: A
authors.lastname: Kebudi
authors.affiliation: Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey.
authors.forename: N Zafer
authors.initials: NZ
authors.lastname: Cantürk
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Erbil
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Tsaritsa Yoanna University School of Medicine, Sofia, Bulgaria.
authors.forename: Rumen
authors.initials: R
authors.lastname: Pandev
authors.affiliation: Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey.
authors.forename: Bahadır M
authors.initials: BM
authors.lastname: Güllüoğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001669:Biochemical Phenomena; D059038:Black Sea / Q000453:epidemiology; D002118:Calcium / Q000032:analysis / Q000097:blood; D005260:Female; D006750:Hospital Distribution Systems / Q000706:statistics & numerical data*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000032:analysis / Q000097:blood; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium
keywords: Bulgaria; Turkey; clinocopathological features; hyperparathyroidism; regional differences