Repplinger Daniel, Schaefer Sarah, Chen Herbert, Sippel Rebecca S
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Surgery. 2009 Dec;146(6):1138-43. doi: 10.1016/j.surg.2009.09.009.
To determine whether a symptomatic presentation was associated with parathyroid hyperplasia, we retrospectively examined pre-operative symptom profiles of patients who underwent parathyroidectomy.
From October 2007 to July 2008, 111 patients with primary hyperparathyroidism completed a preoperative symptom questionnaire prior to parathyroidectomy. The symptom profiles of patients with and without hyperplasia were compared.
Neurocognitive symptoms occurred in 51.4% of patients. Patients with 1 neurocognitive symptom had a 25% risk of parathyroid hyperplasia. Additional neurocognitive symptoms increased the risk of hyperplasia linearly, with hyperplasia occurring in 38% of patients reporting 2 neurocognitive symptoms (P < .001) and 61% of patients reporting 3 or more of these symptoms (P < .001). A negative sestamibi scan was associated with a 33% risk of hyperplasia. Coupled with at least 1 neurocognitive symptom, the risk of hyperplasia was 53.3% (P < .001). Of patients with 3 or more neurocognitive symptoms and a negative localizing scan, 100% were found to have parathyroid hyperplasia (P < .001).
The presence of neurocognitive dysfunction in a patient with hyperparathyroidism may be used as a predictor of hyperplastic disease. Three or more of these symptoms, coupled with a negative sestamibi scan, was 100% predictive of parathyroid hyperplasia in our cohort.
为了确定症状表现是否与甲状旁腺增生有关，我们回顾性地研究了接受甲状旁腺切除术患者的术前症状特征。
2007年10月至2008年7月，111例原发性甲状旁腺功能亢进患者在甲状旁腺切除术前完成了一份术前症状问卷。比较了有增生和无增生患者群的症状特征。
51.4%的患者出现神经认知症状。有1种神经认知症状的患者甲状旁腺增生风险为25%。额外的神经认知症状会使增生风险呈线性增加，报告2种神经认知症状的患者中38%发生增生（P <.001），报告3种或更多此类症状的患者中61%发生增生（P <.001）。99m锝-甲氧基异丁基异腈（sestamibi）扫描结果为阴性与33%的增生风险相关。若伴有至少1种神经认知症状，增生风险为53.3%（P <.001）。在有3种或更多神经认知症状且定位扫描结果为阴性的患者中，100%被发现有甲状旁腺增生（P <.001）。
甲状旁腺功能亢进患者出现神经认知功能障碍可作为增生性疾病的一个预测指标。在我们的队列研究中，这些症状出现3种或更多，再加上sestamibi扫描结果为阴性，对甲状旁腺增生的预测率为100%。
