Wells S A
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Bone Miner Res. 1991 Oct;6 Suppl 2:S143-9; discussion S151-2. doi: 10.1002/jbmr.5650061429.
Primary hyperparathyroidism was thought 30 years ago to be a rare disease, and the diagnosis was most often made in patients presenting with either bone disease or kidney stones. Today the minority of patients with hyperparathyroidism present with such symptoms, a fact accounted for by the introduction into general medical practice three decades ago of laboratory technology for efficiently determining the serum concentrations of various blood minerals, including calcium. Hypercalcemia was detected more frequently, and it was realized that most patients with hyperparathyroidism either had minor symptoms, such as constipation, polyuria, tiredness, and muscle weakness, or they were "asymptomatic" and indistinguishable from normal subjects. It was thought that primary hyperparathyroidism was a progressive disease and that sooner or later all patients would become symptomatic and require parathyroidectomy. Since this operation was curative in a high percentage of cases, it was recommended for virtually all patients once the diagnosis was established. In this contribution the long-term benefits of parathyroidectomy in patients with and without symptoms from primary hyperparathyroidism are reviewed. It is concluded that a multicenter prospective randomized trial is needed to resolve the indications for operative and nonoperative management of patients with this disease.
30年前，原发性甲状旁腺功能亢进被认为是一种罕见疾病，诊断通常是在出现骨病或肾结石的患者中做出的。如今，甲状旁腺功能亢进患者中少数会出现此类症状，这一事实可归因于30年前普通医疗实践中引入了能有效测定包括钙在内的各种血液矿物质血清浓度的实验室技术。高钙血症被更频繁地检测到，人们意识到大多数甲状旁腺功能亢进患者要么有轻微症状，如便秘、多尿、疲劳和肌肉无力，要么是“无症状的”，与正常受试者无异。人们认为原发性甲状旁腺功能亢进是一种进行性疾病，迟早所有患者都会出现症状并需要进行甲状旁腺切除术。由于这种手术在很大比例的病例中具有治愈性，一旦确诊，几乎所有患者都被建议进行手术。在本论文中，我们回顾了甲状旁腺切除术对有症状和无症状的原发性甲状旁腺功能亢进患者的长期益处。得出的结论是，需要进行一项多中心前瞻性随机试验来确定这种疾病患者手术和非手术治疗的指征。
