Ultrasonography for early detection of enlarged secondary parathyroid gland in patient with end stage renal disease: Prediction by clinical features.

Objectives: To determine the association between the numbers of clinical features either due to end stage renal failure (ESRF) or Secondary hyperparathyroidism (SHPT) and size of parathyroid gland. Methodology: An analytical study was carried out between 1st of January to 30th of June of 2006 by the collaboration of nephrology centre and radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Patients with (ESRF) on hemodialysis for more than 12 months, receiving medical treatment who had increased parathyroid hormone level with more than one clinical features of hyperparathyroidism were selected. Subjects were divided into two categories, having enlarged (A) and not enlarged (B) parathyroid glands. Ultrasonographic examinations of the neck were performed by using high frequency transducers in the range of 7.5 to 10 MHz by using Aloka pro sound 5500 machine. Pearson correlation (r) and linear regression analysis was done between number of clinical features and number of subjects in each category. Results: Only 17(31%) were found to have enlarged gland out of total 54 subjects. Males 32(59%) outnumbered the females. Subjects’ Parathyroid hormone ranged from 111-6047 pg/ml with mean 1266±994 (SD), while for subjects with enlarged glands the range was 820-6047 pg/ml with mean 1645±804 (SD). Number of subjects in category A were found to increase with increase in frequency of clinical features by doing regression analysis with correlation coefficient (r=0.98, p=0.002) while category B didn’t show any kind of correlation (r=0.36, p>0.54). Comparison of correlation by Fisher’s Z transformation of data a significant difference was found between categories A and B (p<0.05). Conclusion: Frequency of subjects with enlarged gland increased with increasing number of clinical features. [ABSTRACT FROM AUTHOR]