Hyperparathyroidism study findings from a New Delhi hospital suggest that more than a third of primary hyperparathyroidism cases now present without symptoms, a shift from the severe symptomatic disease that historically characterised the condition in India. The retrospective study, published in the Indian Journal of Endocrinology and Metabolism in August 2026, was reported by Medical Dialogues on 2 November 2026.
The hyperparathyroidism study evaluated 90 patients treated at a New Delhi tertiary centre between January 2020 and July 2024. Of those, 58 patients had symptoms and 32 had no symptoms, which gives the asymptomatic share of 35.6 percent. The researchers compared parathyroidectomy, the surgical removal of overactive parathyroid tissue, against cinacalcet, a drug that lowers calcium and parathyroid hormone levels.
Dr Aditya Dutta and colleagues from the Department of Endocrinology at Max Super Speciality Hospital, New Delhi, carried out the work. Their aim was to characterise clinical presentations and to evaluate real world outcomes of surgery and cinacalcet, in a setting where Indian evidence on medical calcimimetic therapy has been scarce.
Hyperparathyroidism study compares symptomatic and silent cases
Primary hyperparathyroidism, often shortened to PHPT, happens when one or more parathyroid glands produce too much parathyroid hormone, which raises blood calcium. High calcium can affect bones, kidneys and digestion, although some patients show no outward signs and the condition is picked up through blood tests done for other reasons.
The hyperparathyroidism study found that symptomatic patients had significantly higher parathyroid hormone levels than asymptomatic patients, at 201.7 versus 143 pg/mL, higher creatinine at 0.77 versus 0.66 mg/dL, and greater sestamibi scan localisation at 80.7 percent versus 54.8 percent. Asymptomatic patients showed lower bone mineral density at the distal radius, at 0.533 versus 0.663 g per square centimetre, a finding that points to bone effects even when symptoms are absent.
Ultrasound localised parathyroid lesions in both groups at similar rates, at 77.6 percent for symptomatic patients and 78.1 percent for asymptomatic patients. Sestamibi scans, a nuclear medicine imaging method, localised lesions better in symptomatic cases. The authors concluded that clinical profiles of asymptomatic and symptomatic disease were largely similar apart from those differences, which is why they called for diagnostic vigilance when a patient shows raised calcium without symptoms.
Hyperparathyroidism study results for surgery and cinacalcet
Forty five patients in the study underwent parathyroidectomy and 45 received cinacalcet, at a median dose of 30 mg daily, with a median follow up of eight months. In the hyperparathyroidism study, surgery achieved complete cure in all surgical patients. At six weeks, surgical patients had lower serum calcium than medically managed patients, at 9.3 versus 9.9 mg/dL, and lower parathyroid hormone, at 38.5 versus 107 pg/mL.
Cinacalcet normalised serum calcium in 90 percent of follow up patients, with calcium falling from 11.5 to 9.9 mg/dL and parathyroid hormone falling from 165 to 107 pg/mL in that group. The figures were reported for 27 of 30 follow up patients. Transient nausea in 17.8 percent of the cinacalcet group, or 8 of 45 patients, was the sole side effect reported.
The hyperparathyroidism study authors concluded that clinicians may consider cinacalcet as a viable non surgical option for achieving biochemical control and normal calcium in patients who decline surgery, who have operative contraindications, or who require bridging therapy before an operation. Surgery remains the definitive cure in the study results, while cinacalcet provides effective short term calcium normalisation for patients who cannot undergo surgery or choose not to.
Hyperparathyroidism study limits and what comes next
The hyperparathyroidism study has clear limits, which its authors set out. It was retrospective and single centre, with a sample size of 90 patients and a median follow up of eight months. Those limits mean the results describe outcomes at one urban tertiary hospital over a short period, rather than long term results across India.
The authors said prospective trials are needed to evaluate long term skeletal, renal and biochemical effects of medical therapy versus surgery. Longer follow up would show whether calcium control with cinacalcet holds over years, and whether bone density and kidney function differ between patients treated surgically and those treated medically.
For clinicians, the immediate message of the hyperparathyroidism study is narrower. A raised calcium result without symptoms should not be dismissed, since more than a third of cases in this cohort presented that way and still showed bone effects. The choice between surgery and cinacalcet, the study suggests, can be made case by case, with surgery offering cure and cinacalcet offering control when surgery is not possible or not wanted.