Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
J Am Coll Surg. 2011 Sep;213(3):410-4. doi: 10.1016/j.jamcollsurg.2011.06.401. Epub 2011 Jul 1.
Primary hyperparathyroidism presents with a myriad of symptoms, which range in severity. The cause of these symptoms is not well understood. We sought to determine if the severity of preoperative biochemical abnormalities (calcium, parathyroid hormone, vitamin D levels) correlated with symptomatology in patients undergoing surgical treatment for primary hyperparathyroidism.
Over 15 months, 229 consecutive patients with primary hyperparathyroidism completed a symptom questionnaire before parathyroidectomy. The symptom profiles of patients with significant hypercalcemia at initial presentation (≥11.2 mg/dL) and those with baseline calcium levels (<11.2 mg/dL) were compared. The patients were also categorized based on parathyroid hormone (< or ≥130 pg/mL) and vitamin D (< or ≥30 ng/mL) and analyzed in a similar manner.
Seventy-eight patients (34%) had a baseline calcium ≥11.2 mg/dL, but compared with patients with calcium <11.2 mg/dL, only the incidence of nephrolithiasis was more common in those patients with significant hypercalcemia (18% vs 9%, p = 0.04). Conversely, depression, bone or joint pain, and constipation were all significantly more common in patients with calcium <11.2mg/dL (p = 0.006, 0.001, and 0.031, respectively). Patients analyzed based on parathyroid hormone and vitamin D levels showed no significant difference in symptom presentation.
These data indicate that the degree of parathyroid hormone elevation and the presence of vitamin D deficiency do not correlate with the presence of symptoms in patients with primary hyperparathyroidism. Significant hypercalcemia was associated with nephrolithiasis, but interestingly, patients with milder hypercalcemia had significantly more depression, bone or joint pain, and constipation, suggesting that these symptoms are likely not mediated by hypercalcemia.
原发性甲状旁腺功能亢进症表现出多种症状，严重程度不一。这些症状的原因尚不清楚。我们试图确定在接受手术治疗的原发性甲状旁腺功能亢进症患者中，术前生化异常（钙、甲状旁腺激素、维生素 D 水平）的严重程度是否与症状相关。
在 15 个月的时间里，229 例原发性甲状旁腺功能亢进症患者在甲状旁腺切除术前完成了症状问卷。比较了初始表现时血钙显著升高（≥11.2mg/dL）和基线钙水平<11.2mg/dL 的患者的症状谱。还根据甲状旁腺激素（<或≥130pg/mL）和维生素 D（<或≥30ng/mL）对患者进行分类，并以类似方式进行分析。
78 例患者（34%）的基线钙≥11.2mg/dL，但与钙<11.2mg/dL 的患者相比，仅血钙显著升高的患者肾结石的发生率更高（18%比 9%，p=0.04）。相反，抑郁、骨或关节疼痛和便秘在钙<11.2mg/dL 的患者中更为常见（p=0.006、0.001 和 0.031）。根据甲状旁腺激素和维生素 D 水平分析的患者，在症状表现上无明显差异。
这些数据表明，甲状旁腺激素升高的程度和维生素 D 缺乏与原发性甲状旁腺功能亢进症患者的症状存在无关。血钙显著升高与肾结石相关，但有趣的是，血钙较轻的患者出现明显更多的抑郁、骨或关节疼痛和便秘，表明这些症状可能不是由高钙血症引起的。
