[Diagnosis and management of primary hyperparathyrodism with urolithiasis].

OBJECTIVE

To investigate the diagnosis and management of primary hyperparathyroidism with urolithiasis.

METHODS

The clinical data of 12 patients who were diagnosed with primary hyperparathyroidism with urolithiasis from January 1998 to June 2004 were analyzed retrospectively.

RESULTS

Four male and five female patients were demonstrated pathologically as parathyroid adenoma, with a mean age of 45.7 +/- 11.8 years (26 approximately 57) and a stone history of 8.3 +/- 6.4 years (0.5 approximately 22). Their serum calcium and PTH level were elevated obviously, while serum phosphate of 66% patients were lowered. The positive rate and accuracy of ultrasound, CT and (99m)TC-MIBI imaging were 67%, 100%, and 100% and 67%, 75%, 100% respectively. After resection of the parathyroid adenoma, the patients' serum calcium and PTH returned to normal. The other data of 3 cases without parathyroid adenoma. all males aged 45 approximately 54, were also investigated.

CONCLUSIONS

Serum calcium level above 2.96 mmol/L and PTH 3.9 or more times as normal in patients with recurrent or bilateral urolithiasis should be suspected with primary hyperparathyroidism. (99m)TC-MIBI image functions best in preoperative localization of the abnormal gland. Parathyroidectomy is the curative approach for the disease. Stones should be followed up after operation and appropriate treatment should be employed when needed.