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Pathological fracture: a common presentation of primary hyperparathyroidism in Iraq.

OBJECTIVE
To describe our experience with severe primary hyperparathyroidism.


DESIGN
Prospective open study.


SETTING
City hospital, Iraq.


SUBJECTS
15 patients with confirmed severe hyperparathyroidism operated on during the period 1985-92.


INTERVENTION
Neck exploration was performed for all patients.


MAIN OUTCOME MEASURES
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.


CONCLUSION
Primary hyperparathyroidism is an underdiagnosed disorder in Iraq, and most patients present with advanced disease. Surgical treatment is indicated and the results are good.