Oliveira U E M, Ohe M N, Santos R O, Cervantes O, Abrahão M, Lazaretti-Castro M, Vieira J G H, Hauache O M
Disciplina de Endocrinologia e Metabologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brasil.
Braz J Med Biol Res. 2007 Apr;40(4):519-26. doi: 10.1590/s0100-879x2007000400010.
Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.
原发性甲状旁腺功能亢进是一种临床表现多样的内分泌疾病，在西方国家常表现为无症状性高钙血症，但在发展中国家仍主要表现为有症状的疾病。这项回顾性研究的目的是描述在一家大学医院就诊的原发性甲状旁腺功能亢进患者的诊断表现特征、甲状旁腺切除术指征及术后骨密度随访情况。我们发现了115例在过去20年中被诊断为原发性甲状旁腺功能亢进的患者（92例女性，中位年龄56岁）。我们根据是否存在影响骨骼、肾脏或神经肌肉系统的任何典型症状来定义有症状的患者。手术标准遵循美国国立卫生研究院关于无症状原发性甲状旁腺功能亢进的指南。有症状的患者和符合甲状旁腺切除术手术标准的患者分别占样本的66%和93%。钙和甲状旁腺激素的中位值分别为11.9mg/dL和189pg/mL。手术治疗后，97%的患者治愈，术后3年腰椎骨密度增加19.4%，股骨颈骨密度增加15.7%。在绝经前女性、男性以及有症状和较年轻的患者中，腰椎和股骨颈的骨量增加更为明显。我们的结果支持了之前的研究发现，即该病主要表现为有症状的疾病，其表现特征可能主要与诊断延迟有关。然而，遗传和种族背景以及钙和维生素D缺乏等营养因素可能在巴西患者原发性甲状旁腺功能亢进的临床表现中起作用。
