Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
J Clin Densitom. 2013 Jan-Mar;16(1):14-21. doi: 10.1016/j.jocd.2012.11.005.
The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term "asymptomatic primary hyperparathyroidism" was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease.
原发性甲状旁腺功能亢进症(PHPT)在美国和大多数西方国家的临床表现,在过去半个世纪中发生了显著变化。20 世纪 70 年代多通道血清自动分析仪的引入,使得人们认识到了一群无症状高钙血症患者,对这些患者的评估导致了 PHPT 的诊断。“无症状原发性甲状旁腺功能亢进症”这一术语被用来描述那些缺乏明显的与钙或甲状旁腺激素过多有关的体征和症状的患者。尽管人们预计无症状患者最终会发展为典型的 PHPT 症状,但观察数据表明,大多数患者不会随着时间的推移而变得明显有症状。在世界上大多数地区,PHPT 的无症状表型已经取代了经典 PHPT。本报告是对无症状 PHPT 的相关数据的选择性回顾:其人口统计学特征、表现和自然病史,以及生化、骨骼、神经肌肉、心理和心血管表现。此外,我们还将总结目前关于无症状疾病治疗指征和选择的信息。