Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Endocr Pract. 2012 Sep-Oct;18(5):781-90. doi: 10.4158/EP12166.RA.
To review primary hyperparathyroidism and the key issues that are relevant to the practicing endocrinologist.
The latest information on the presentation, diagnosis, and traditional and nontraditional aspects of primary hyperparathyroidism is reviewed.
The diagnosis of primary hyperparathyroidism is straightforward when the traditional hypercalcemic patient is documented to have an elevated parathyroid hormone (PTH) level. Commonly, patients are identified who have normal serum calcium levels but elevated PTH levels in whom no secondary causes for hyperparathyroidism can be confirmed. Traditional target organs of primary hyperparathyroidism-the skeleton and the kidneys-continue to be a focus in the patient evaluation. Bone mineral density shows a typical pattern of involvement with the distal one-third radius being selectively reduced compared with the lumbar spine in which bone mineral density is generally well maintained. Neurocognitive and cardiovascular aspects of primary hyperparathyroidism, while a focus of recent interest, have not been shown to definitively aid in the decision for or against surgery. The recommendation for surgery in primary hyperparathyroidism is based on guidelines that focus on the serum calcium level, renal function, bone mineral density, and age. In patients who do not meet guidelines, a nonsurgical management approach has merit.
Primary hyperparathyroidism is continuing to show changes in its clinical profile, with normocalcemic primary hyperparathyroidism being a topic of great interest. Skeletal and renal features of primary hyperparathyroidism drive, in most cases, the decision to recommend surgery. In patients who do not meet any criteria for surgery, a conservative approach with appropriate monitoring is acceptable.
综述原发性甲状旁腺功能亢进症及与临床内分泌医生相关的关键问题。
对原发性甲状旁腺功能亢进症的临床表现、诊断以及传统和非传统方面的最新信息进行了复习。
当传统的高钙血症患者被证实甲状旁腺激素（PTH）水平升高时，原发性甲状旁腺功能亢进症的诊断是直接的。通常，会发现一些患者的血清钙水平正常，但甲状旁腺激素水平升高，且不能确认继发性甲状旁腺功能亢进症的原因。原发性甲状旁腺功能亢进症的传统靶器官——骨骼和肾脏，仍然是患者评估的重点。骨密度显示出一种典型的受累模式，与腰椎相比，远端三分之一的桡骨骨密度选择性降低，而腰椎的骨密度通常保持良好。原发性甲状旁腺功能亢进症的神经认知和心血管方面虽然是最近关注的焦点，但尚未被证明有助于明确手术的决策。原发性甲状旁腺功能亢进症的手术推荐是基于关注血清钙水平、肾功能、骨密度和年龄的指南。对于不符合指南的患者，非手术治疗方法是有价值的。
原发性甲状旁腺功能亢进症的临床表现仍在不断变化，其中低钙血症原发性甲状旁腺功能亢进症是一个非常关注的话题。原发性甲状旁腺功能亢进症的骨骼和肾脏特征在大多数情况下驱动着手术推荐的决策。对于不符合手术标准的患者，采用适当监测的保守方法是可以接受的。
