Identifying Patients With Asymptomatic Hyperparathyroidism by Serum Calcium and Vitamin D Screening in West Bengal, India

Abstract

BACKGROUND: Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia, with solitary parathyroid adenoma responsible for most cases. Many patients with hyperparathyroidism remain asymptomatic, but early detection and parathyroidectomy can prevent complications such as nephrolithiasis, pancreatitis, and bone and kidney disorders. This study emphasizes the importance of screening for asymptomatic hyperparathyroidism to enable timely intervention. METHODS: Serum calcium and Vitamin D3 levels were screened in 6000 outpatients between March 2021 and September 2022. Patients with known hyperparathyroidism, conditions altering calcium metabolism, or those on calcium/Vitamin D supplements were excluded. Vitamin D deficiency was corrected in normocalcemic patients, and follow-up calcium levels were measured. Hypercalcaemic cases underwent additional phosphate and intact parathormone (iPTH) testing. Hyperparathyroidism was confirmed using standard diagnostic criteria, followed by gland localisation and surgery. RESULTS: Among 6000 patients screened, 85.2% (5112) had normocalcemia with Vitamin D deficiency. Hypercalcemia was initially observed in three patients, with two additional cases identified post-Vitamin D correction. Of the five hypercalcaemic patients, three were confirmed to have high iPTH levels and low phosphate, leading to surgical intervention. Asymptomatic hyperparathyroidism prevalence was 0.05% (3/6000), constituting 15.8% of all PHPT cases encountered during the study period. CONCLUSION: While global asymptomatic hyperparathyroidism prevalence is approximately 1%, this study observed a lower incidence (0.05%) in a West Bengal population. Despite this, early screening and intervention are vital to prevent long-term complications and reduce healthcare burdens.